Individual
MRS. SHELLYANN TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1445 WOOD MOUNT LN NW #1189, ATLANTA, GA 30318
(770) 380-8821
Mailing address
122 BOMAR LN, DOUGLASVILLE, GA 30134-5188
(770) 380-8821
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
HD000468
GA
335E00000X
Prosthetic/Orthotic Supplier
Primary
HD000468
GA
Other
Enumeration date
06/10/2022
Last updated
06/10/2022
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