Provider Demographics
NPI:1447880869
Name:TAYLOR, CARALISA
Entity type:Individual
Prefix:
First Name:CARALISA
Middle Name:
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 1:3535 PEACHTREE RD NE STE 520-632
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3287
Mailing Address - Country:US
Mailing Address - Phone:678-644-4241
Mailing Address - Fax:
Practice Address - Street 1:2158 CUMBERLAND PKWY SE APT 7404
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4565
Practice Address - Country:US
Practice Address - Phone:678-644-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030002159376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide