Provider Demographics
NPI:1932837739
Name:MILES-TAYLOR, NEKEISHA
Entity Type:Individual
Prefix:
First Name:NEKEISHA
Middle Name:
Last Name:MILES-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 1:3863 HIGHWAY 138 SE STE 1279
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4143
Mailing Address - Country:US
Mailing Address - Phone:404-939-4608
Mailing Address - Fax:
Practice Address - Street 1:3863 HIGHWAY 138 SE STE 1279
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4143
Practice Address - Country:US
Practice Address - Phone:404-939-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010577163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83-3431527OtherPRIVATE HOME CARE