Individual
TAMMY RENA TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1500
(770) 461-2928
Mailing address
6302 LAMP POST PL, COLLEGE PARK, GA 30349-8830
(760) 672-5944
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN078353
GA
Other
Enumeration date
02/14/2023
Last updated
02/19/2023
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