Provider Demographics
NPI:1689774382
Name:TAYLOR, NADIA DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:DEBORAH
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 1:3371 N BERKELEY LAKE RD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4367
Mailing Address - Country:US
Mailing Address - Phone:404-625-0531
Mailing Address - Fax:
Practice Address - Street 1:4900 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1555
Practice Address - Country:US
Practice Address - Phone:954-327-4060
Practice Address - Fax:305-569-0752
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056229208000000X, 2080P0207X, 208D00000X
FLME1510972080A0000X, 2080B0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA385754109MMedicaid