Provider Demographics
NPI:1669635629
Name:TAYLOR, VANESSA MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GROVE CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-8519
Mailing Address - Country:US
Mailing Address - Phone:770-375-0608
Mailing Address - Fax:
Practice Address - Street 1:201 GROVE CT
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-8519
Practice Address - Country:US
Practice Address - Phone:770-375-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172863363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health