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NPI Code Detail

MEDICARE: KATHRYN NEWSOM TAYLOR D.O.

MEDICARE: KATHRYN NEWSOM TAYLOR D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0402XNeurology with Special Qualifications in Child Neurology Physician87822SC

General Provider Information

NPI Number : 1932632254
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN NEWSOM TAYLOR D.O.
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-3307
Fax Number :
Provider Business Practice Location Address
First Line : 2250 MALL DR
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6563
Country : US
Telephone Number : 843-792-3307
Fax Number : 843-792-6707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2017
Last Update Date : 01/23/2023

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