Provider Demographics
NPI:1942299615
Name:TAYLOR, PAMELA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 COLLEGE CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3629
Mailing Address - Country:US
Mailing Address - Phone:706-372-6055
Mailing Address - Fax:706-354-6972
Practice Address - Street 1:1551 JENNINGS MILL RD
Practice Address - Street 2:SUITE 2000B
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2544
Practice Address - Country:US
Practice Address - Phone:706-372-6055
Practice Address - Fax:706-354-6972
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001827103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0005479097OtherAETNA
GA52818639 003OtherBCBSGA
GA68BBFKKMedicare ID - Type Unspecified
GAS63712Medicare UPIN