Healthcare Provider Details

I. General information

NPI: 1891787578
Provider Name (Legal Business Name): MARK E TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CLYBURN PL
AIKEN SC
29801-4193
US

IV. Provider business mailing address

1000 CLYBURN PL
AIKEN SC
29801-4193
US

V. Phone/Fax

Practice location:
  • Phone: 803-380-7000
  • Fax: 803-502-4248
Mailing address:
  • Phone: 803-380-7000
  • Fax: 803-502-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number055797
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37534
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: