Provider Demographics
NPI:1932127636
Name:TAYLOR, MARIE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ELIZABETH
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:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-227-4068
Mailing Address - Fax:314-454-5628
Practice Address - Street 1:6019 WALNUT GROVE ROAD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-226-0340
Practice Address - Fax:901-226-0349
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P662085R0001X
TN489882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208279208Medicaid
MO208279208Medicaid
030010378Medicare PIN
920000925Medicare PIN