Provider Demographics
NPI:1700879012
Name:TAYLOR, ROBERT E (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:5281 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527-2205
Practice Address - Country:US
Practice Address - Phone:770-983-7611
Practice Address - Fax:770-983-9143
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA031338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00404544CMedicaid
GA00404544CMedicaid
GA08BBWBKMedicare PIN