Provider Demographics
NPI:1114946001
Name:TAYLOR, DEBORAH JO (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5929
Mailing Address - Country:US
Mailing Address - Phone:864-431-4666
Mailing Address - Fax:
Practice Address - Street 1:240 LAURELWOOD DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5929
Practice Address - Country:US
Practice Address - Phone:864-431-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46535207Q00000X
NC2010-01579207Q00000X
SC28274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1316155112OtherGROUP NPI
SCGP4950Medicaid
1992968929OtherGROUP NPI
NC1114946001Medicaid
SC282740Medicaid
SCI51364Medicaid
SC282740Medicaid
SC1316155112OtherGROUP NPI
SCI51364Medicare UPIN
I513648784Medicare PIN
SC282740Medicaid
SCGP4950Medicaid