Provider Demographics
NPI:1265832273
Name:JOHNSON, TAYLAR SUZANNE
Entity Type:Individual
Prefix:
First Name:TAYLAR
Middle Name:SUZANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FRASIER FIR LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8532
Mailing Address - Country:US
Mailing Address - Phone:803-243-4357
Mailing Address - Fax:
Practice Address - Street 1:46 FRASIER FIR LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8532
Practice Address - Country:US
Practice Address - Phone:803-243-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program