Provider Demographics
NPI:1407036734
Name:TAYLOR, CHARIS PRICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARIS
Middle Name:PRICHARD
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 1:7182 WOODROW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2958
Mailing Address - Country:US
Mailing Address - Phone:803-749-1111
Mailing Address - Fax:803-749-0050
Practice Address - Street 1:7182 WOODROW ST STE 200
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2958
Practice Address - Country:US
Practice Address - Phone:803-749-1111
Practice Address - Fax:803-749-0050
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAN3187956-R35207R00000X
SC32671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ95000Medicaid
SCQ95000Medicaid