Provider Demographics
NPI:1932124005
Name:TAYLOR, SCARLET R (MD)
Entity Type:Individual
Prefix:DR
First Name:SCARLET
Middle Name:R
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:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:1316 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7653
Practice Address - Country:US
Practice Address - Phone:803-358-1191
Practice Address - Fax:803-358-1180
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC269140Medicaid
SCI594992811OtherMEDICARE GROUP NUMBER
SCAA7584A871OtherMEDICARE PTAN
SC269140Medicaid
SCI594992811OtherMEDICARE GROUP NUMBER