Provider Demographics
NPI:1891787578
Name:TAYLOR, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CLYBURN PL
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4193
Mailing Address - Country:US
Mailing Address - Phone:803-380-7000
Mailing Address - Fax:803-502-4248
Practice Address - Street 1:1000 CLYBURN PL
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4193
Practice Address - Country:US
Practice Address - Phone:803-380-7000
Practice Address - Fax:803-502-4248
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055797207Q00000X
SC37534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA980939645CMedicaid
GU000471809CMedicaid
GA341630OtherWELLCARE MCAID
GA342410OtherWELLCARE MCAID
GA341630OtherWELLCARE
GA980939645EMedicaid
GA341628OtherWELLCARE MCAID
GA341629OtherWELLCARE
GA980939645GMedicaid
GA000471809AMedicaid
GA10060509OtherAMERIGROUP
GA980939645FMedicaid
GA000467519AMedicaid
GA000471809BMedicaid
GA10060509OtherAMERIGROUP MCAID
GA980939645EMedicaid
GA341630OtherWELLCARE
GU000471809CMedicaid
GA980939645FMedicaid
GA000471809BMedicaid
ID111813Medicare Oscar/Certification