Provider Demographics
NPI:1689343667
Name:ELLISON, TAYLOR HAMILTON (MS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:HAMILTON
Last Name:ELLISON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MAKENZIE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1855 PALOMINO CIR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-9023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1855 PALOMINO CIR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-9023
Practice Address - Country:US
Practice Address - Phone:803-972-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education