Provider Demographics
NPI:1689280307
Name:TAYLOR, CHRISTOPHER EARL
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EARL
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 1:1515 TIMBERLINE TRCE
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6619
Mailing Address - Country:US
Mailing Address - Phone:678-852-5705
Mailing Address - Fax:
Practice Address - Street 1:1515 TIMBERLINE TRCE
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6619
Practice Address - Country:US
Practice Address - Phone:678-852-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB599799106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician