Taylor Keith Baucom, PA-C
Physician Assistant in Little River, SC. Individual provider (NPI-1).
NPI number1891479929
StatusActive
Last updated in NPPESJun 9, 2023
Details
- NPI
- 1891479929
- Entity type
- Individual (NPI-1)
- Name
- Mr. Taylor Keith Baucom
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 9, 2023
- Certification date
- Jun 2, 2023
- Last updated
- Jun 9, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 4861 | SC | Yes |
Practice location
3793 McDowell LnMedical Park 2, Suite 100
Little River, SC 29566
Phone 843-390-0100
Mailing address
4917 Campobello DrMonroe, NC 28110
Phone 704-221-6042
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All 15 Physician Assistant providers in Little River · All 468 providers in Little River
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