Provider Demographics
NPI:1487268926
Name:GRAHAM, TAYLOR (LMSW)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:HEADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:144 SNOW BIRD DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3528
Mailing Address - Country:US
Mailing Address - Phone:256-322-1913
Mailing Address - Fax:
Practice Address - Street 1:1101 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5832
Practice Address - Country:US
Practice Address - Phone:404-450-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1710289541Medicaid