Provider Demographics
NPI:1972623866
Name:TAYLOR, ROSE M (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:715 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3379
Mailing Address - Country:US
Mailing Address - Phone:404-299-8444
Mailing Address - Fax:404-292-8824
Practice Address - Street 1:715 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3379
Practice Address - Country:US
Practice Address - Phone:404-299-8444
Practice Address - Fax:404-292-8824
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA026666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002416OtherGROUP MEDICARE #
GA00335805DMedicaid
GAD46299Medicare UPIN