Healthcare Provider Details

I. General information

NPI: 1407483142
Provider Name (Legal Business Name): TAYLOR RAY MACDONALD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

171 ASHLEY AVE
CHARLESTON SC
29425-0100
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3451
  • Fax:
Mailing address:
  • Phone: 843-985-5500
  • Fax: 843-985-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number1407483142
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: