Provider Demographics
NPI:1225243926
Name:TAYLOR, TANA (ARRT RT (R)(M)(CT))
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ARRT RT (R)(M)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SHELLFIELD RD APT 722
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330
Mailing Address - Country:US
Mailing Address - Phone:334-494-1400
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-695-6702
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT138032471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCRT13803OtherRADIOLOGIC TECHNOLOGIS