Provider Demographics
NPI:1194175380
Name:PADGETT, TAYLOR MARIE
Entity type:Individual
Prefix:
First Name:TAYLOR MARIE
Middle Name:
Last Name:PADGETT
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 1:54 PARADE FARM LN
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:SC
Mailing Address - Zip Code:29030-8479
Mailing Address - Country:US
Mailing Address - Phone:803-747-5547
Mailing Address - Fax:
Practice Address - Street 1:54 PARADE FARM LN
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:SC
Practice Address - Zip Code:29030-8479
Practice Address - Country:US
Practice Address - Phone:803-747-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1843390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program