Healthcare Provider Details

I. General information

NPI: 1447320189
Provider Name (Legal Business Name): KEITH A TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 GRAYS HWY
RIDGELAND SC
29936-5440
US

IV. Provider business mailing address

721 OKATIE HWY
OKATIE SC
29909-3963
US

V. Phone/Fax

Practice location:
  • Phone: 843-726-3979
  • Fax:
Mailing address:
  • Phone: 843-987-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30277
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30277
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD424158
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: