Provider Demographics
NPI:1225835275
Name:TAYLOR-TRAVIS, SHAWNTRICE
Entity type:Individual
Prefix:
First Name:SHAWNTRICE
Middle Name:
Last Name:TAYLOR-TRAVIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 DUNWOODY PL # 7446
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2995
Mailing Address - Country:US
Mailing Address - Phone:404-462-0655
Mailing Address - Fax:404-462-0655
Practice Address - Street 1:8735 DUNWOODY PL # 7446
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:404-462-0655
Practice Address - Fax:404-462-0655
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA372500000X, 372600000X, 3747P1801X, 374U00000X, 172A00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker