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Individual
TEDDIE DEMONT TAYLOR
Active
Individual
TEDDIE DEMONT TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049499084
GA DL
GA
Enumeration date
12/04/2018
Last updated
06/11/2019
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