Provider Demographics
NPI:1245126580
Name:TAYLOR, BLAKE WILLIAM
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:WILLIAM
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 1:603 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-7018
Mailing Address - Country:US
Mailing Address - Phone:762-887-0938
Mailing Address - Fax:
Practice Address - Street 1:4083 CLOUD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-8411
Practice Address - Country:US
Practice Address - Phone:877-654-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)