Provider Demographics
NPI:1417755281
Name:TEAT, CANDACE TAYLOR (FNP, BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:TAYLOR
Last Name:TEAT
Suffix:
Gender:
Credentials:FNP, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 WALL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4992
Mailing Address - Country:US
Mailing Address - Phone:678-978-7300
Mailing Address - Fax:
Practice Address - Street 1:128 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2154
Practice Address - Country:US
Practice Address - Phone:678-632-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA223190208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice