Provider Demographics
NPI:1710445499
Name:GRATE-TAYLOR, TOMEKA
Entity Type:Individual
Prefix:MRS
First Name:TOMEKA
Middle Name:
Last Name:GRATE-TAYLOR
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 1:425 SUMMIT TERRACE CT STE 1A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7056
Mailing Address - Country:US
Mailing Address - Phone:803-939-6147
Mailing Address - Fax:803-939-6148
Practice Address - Street 1:425 SUMMIT TERRACE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7055
Practice Address - Country:US
Practice Address - Phone:803-939-6147
Practice Address - Fax:803-939-6148
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
SCEX17943747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1710445499Medicaid
SCEX1794Medicaid