Provider Demographics
NPI:1861465866
Name:TAYLOR, GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
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:PO BOX 200128
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9003
Mailing Address - Country:US
Mailing Address - Phone:770-386-1261
Mailing Address - Fax:770-382-9343
Practice Address - Street 1:4904 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1828
Practice Address - Country:US
Practice Address - Phone:770-942-4822
Practice Address - Fax:770-942-5311
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056389208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BDHWPMedicare ID - Type Unspecified
GAG78730Medicare UPIN