Healthcare Provider Details

I. General information

NPI: 1205725850
Provider Name (Legal Business Name): TAYLOR DEHART MD, MSCR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE MAIN HOSPITAL, ROOM 202, MSC333
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVENUE MAIN HOSPITAL, ROOM 202, MSC333
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-7080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94989
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number94989
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: