MEDICARE: KELLY GARRITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0210X	Pediatric Nephrology Physician	92622	SC

General Provider Information

NPI Number	:	1437504586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY GARRITY

Provider Business Mailing Address
First Line	:	312 N MYERS ST
Second Line	:	STE 416
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-3046
Country	:	US
Telephone Number	:	240-252-9871
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 MCCLELLAND BANKS DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-0001
Country	:	US
Telephone Number	:	240-252-9871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/06/2026

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