Provider Demographics
NPI:1255893475
Name:TAYLOR, TAMARA LYNETTE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S LEA CT SE APT B
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1700
Mailing Address - Country:US
Mailing Address - Phone:678-793-3438
Mailing Address - Fax:
Practice Address - Street 1:1300 S LEA CT SE APT B
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1700
Practice Address - Country:US
Practice Address - Phone:678-793-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47586-PT18246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy