Healthcare Provider Details

I. General information

NPI: 1831965607
Provider Name (Legal Business Name): TIARA EVETTE EADY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SAM RITTENBERG BLVD
CHARLESTON SC
29407-4936
US

IV. Provider business mailing address

1850 SAM RITTENBERG BLVD
CHARLESTON SC
29407-4936
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-6093
  • Fax:
Mailing address:
  • Phone: 843-793-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMPA.5126
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: