Provider Demographics
NPI:1669826111
Name:TAYLOR, ANTOINETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-3468
Mailing Address - Country:US
Mailing Address - Phone:662-473-4050
Mailing Address - Fax:662-473-3343
Practice Address - Street 1:604 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965
Practice Address - Country:US
Practice Address - Phone:662-473-4050
Practice Address - Fax:662-473-3343
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine