Provider Demographics
NPI:1619596293
Name:HEACOCK, TAYLOR LYNN (MD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:HEACOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-8035
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:3905 BROOKSIDE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4457
Practice Address - Country:US
Practice Address - Phone:770-751-3600
Practice Address - Fax:770-751-3615
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA100050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology