Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 504 | SC |
Y | 103TC0700X | Clinical Psychologist | 504 | SC |
NPI | 1013153576 |
---|---|
Provider Name | Dr. John Michale Taylor |
First Address | Columbia, SC 29203-6894 |
Second Address | Columbia, SC 29203-6863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 14/12/2017 |