Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN010999 | GA |
Y | 213EG0000X | General Practice | DN010999 | GA |
NPI | 1003869736 |
---|---|
Provider Name | Judy Greenlea Taylor |
First Address | Union City, GA 30291-2057 |
Second Address | Decatur, GA 30030-1715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |