Provider Demographics
NPI:1750788105
Name:STONE, TAYLOR RAE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:RAE
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 412
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1758
Practice Address - Country:US
Practice Address - Phone:404-459-9177
Practice Address - Fax:404-389-0400
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA7532363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical