Provider Demographics
NPI:1720616006
Name:DAVIS, TAYLOR BRADY (DO)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:BRADY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E TOWN ST STE 116
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4799
Mailing Address - Country:US
Mailing Address - Phone:614-566-9108
Mailing Address - Fax:614-566-8737
Practice Address - Street 1:393 E TOWN ST STE 116
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4799
Practice Address - Country:US
Practice Address - Phone:614-566-9108
Practice Address - Fax:614-566-8737
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH1720616006207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program