Provider Demographics
NPI:1508513730
Name:BRANHAM, TAYLOR EVANS (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:EVANS
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN ST N
Practice Address - Street 2:
Practice Address - City:BETHUNE
Practice Address - State:SC
Practice Address - Zip Code:29009-9750
Practice Address - Country:US
Practice Address - Phone:843-334-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant