Healthcare Provider Details

I. General information

NPI: 1063290377
Provider Name (Legal Business Name): TAYLER HAMMINGTON IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 598 MCAS BEAUFORT
BEAUFORT SC
29904
US

IV. Provider business mailing address

117 PALMETTO BREEZE CIR
BEAUFORT SC
29907-1599
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-7660
  • Fax:
Mailing address:
  • Phone: 253-315-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: