Provider Demographics
NPI:1184366445
Name:TAYLOR, AUSTIN CHRISTOPHER (PA-S, ATC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CHRISTOPHER
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-S, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 LAKE FORREST DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2228
Mailing Address - Country:US
Mailing Address - Phone:770-853-6961
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTURY PKWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3125
Practice Address - Country:US
Practice Address - Phone:470-322-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
GAAT0041702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer