Healthcare Provider Details

I. General information

NPI: 1962322552
Provider Name (Legal Business Name): MICHAEL DEMARIO TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LAUREL ST
COLUMBIA SC
29204-1018
US

IV. Provider business mailing address

432 CHANEY GROVE RD
TIMMONSVILLE SC
29161-8443
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-3278
  • Fax: 803-929-3256
Mailing address:
  • Phone: 843-992-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32318
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: