Provider Demographics
NPI:1861989816
Name:TAYLOR, HEATHER BROOKE
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BROOKE
Last Name: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 1:1111 BAKER HWY W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2107
Mailing Address - Country:US
Mailing Address - Phone:912-389-4453
Mailing Address - Fax:
Practice Address - Street 1:1111 BAKER HWY W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2107
Practice Address - Country:US
Practice Address - Phone:912-389-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered