Provider Demographics
NPI:1235299736
Name:TAYLOR, STEVEN K (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1492 WILDWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2678
Mailing Address - Country:US
Mailing Address - Phone:404-788-1369
Mailing Address - Fax:770-471-8759
Practice Address - Street 1:1492 WILDWOOD WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2678
Practice Address - Country:US
Practice Address - Phone:404-788-1369
Practice Address - Fax:770-471-8759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT61268Medicare UPIN
GAT61268Medicare UPIN