MEDICARE: TAYLOR ANNE WHALEY PA

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	363A00000X	Physician Assistant	4775	SC
2	363A00000X	Physician Assistant	1200472	SC

General Provider Information

NPI Number	:	1962100909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ANNE WHALEY PA

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MEDICAL PARK CT
Second Line	:
City	:	CLINTON
State	:	SC
Zip	:	29325-7537
Country	:	US
Telephone Number	:	864-358-7387
Fax Number	:	864-938-0229

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

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	03/20/2025

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