Basic Information
| Provider Information | |||||||||
| NPI: | 1225243926 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TAYLOR | ||||||||
| FirstName: | TANA | ||||||||
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| Credential: | ARRT RT (R)(M)(CT) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 SHELLFIELD RD APT 722 | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3344941400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6439 GARNERS FERRY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
| FaxNumber: | 8036956702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3401X | CRT13803 | AZ | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography |
ID Information
| ID | Type | State | Issuer | Description | CRT13803 | 01 | AZ | RADIOLOGIC TECHNOLOGIS | OTHER |