Individual
AMANDA KATHERINE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
(864) 241-1049
Mailing address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
(864) 241-1049
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301100
—
SC
01
—
3333
MEDICARE PROVIDER NUMBER
SC
Enumeration date
01/17/2008
Last updated
01/17/2008
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