MEDICARE: TAYLOR ADDISON PLUMMER-FOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		SC

General Provider Information

NPI Number	:	1477365278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ADDISON PLUMMER-FOX

Provider Business Mailing Address
First Line	:	4 SPRINGDALE DR APT I
Second Line	:
City	:	YORK
State	:	SC
Zip	:	29745-1936
Country	:	US
Telephone Number	:	864-584-1612
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SPRINGDALE DR APT I
Second Line	:
City	:	YORK
State	:	SC
Zip	:	29745-1936
Country	:	US
Telephone Number	:	864-584-1612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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Directions to “ TAYLOR ADDISON PLUMMER-FOX ” Practice Location

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