Provider Demographics
NPI:1649991670
Name:TAYLOR, DEIDRA
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 NORTHSIDE PKWY NW
Mailing Address - Street 2:BLDG. 100 - SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:470-289-6838
Mailing Address - Fax:888-493-1218
Practice Address - Street 1:3715 NORTHSIDE PKWY NW
Practice Address - Street 2:BLDG. 100 - SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:470-289-6838
Practice Address - Fax:888-493-1218
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty