Healthcare Provider Details

I. General information

NPI: 1174569818
Provider Name (Legal Business Name): MONICA TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 OKATIE HIGHWAY
RIDGELAND SC
29936
US

IV. Provider business mailing address

4921 BLUFFTON PKWY APT. 1612
BLUFFTON SC
29910-4610
US

V. Phone/Fax

Practice location:
  • Phone: 843-784-2181
  • Fax: 843-784-6112
Mailing address:
  • Phone: 843-784-2181
  • Fax: 843-784-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35083285
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30220
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: