Provider Demographics
NPI:1699977389
Name:TAYLOR BALL, TAMARA (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:TAYLOR BALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1060
Mailing Address - Country:US
Mailing Address - Phone:404-785-7141
Mailing Address - Fax:404-785-7989
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-7141
Practice Address - Fax:404-785-7989
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65619208000000X, 208000000X
ALMD.30136208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-10104OtherBCBS
AL1699977389OtherTRICARE SOUTH
ALZ10940OtherVIVA HEALTH
AL118355Medicaid
AL122854Medicaid
AL511-06638OtherBCBS