Provider Demographics
NPI:1487124418
Name:TAYLOR, CELESTE NICOLE
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NEW POINT LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-3593
Mailing Address - Country:US
Mailing Address - Phone:404-314-8399
Mailing Address - Fax:
Practice Address - Street 1:88 HIGHLAND XING
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-6052
Practice Address - Country:US
Practice Address - Phone:706-276-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13444-040183500000X
GARPH022837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist