Provider Demographics
NPI:1619587599
Name:TAYLOR, MICHAEL DAMONTA
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAMONTA
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 PINE HILL CT
Mailing Address - Street 2:
Mailing Address - City:BRODNAX
Mailing Address - State:VA
Mailing Address - Zip Code:23920-3331
Mailing Address - Country:US
Mailing Address - Phone:804-821-7245
Mailing Address - Fax:
Practice Address - Street 1:154 PINE HILL CT
Practice Address - Street 2:
Practice Address - City:BRODNAX
Practice Address - State:VA
Practice Address - Zip Code:23920-3331
Practice Address - Country:US
Practice Address - Phone:804-821-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)