Individual
CHARLSIE THOMAS TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5023
Mailing address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5023
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
008235
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008235
LICENSE
GA
Enumeration date
01/09/2017
Last updated
12/03/2020
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