Provider Demographics
NPI:1316156169
Name:TAYLOR, KATHY E (MS, RD, LD, CNSD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 CAMELLIA RIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8960
Mailing Address - Country:US
Mailing Address - Phone:404-616-7552
Mailing Address - Fax:404-616-2422
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-3647
Practice Address - Fax:404-616-2422
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001620133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered