Healthcare Provider Details

I. General information

NPI: 1972240216
Provider Name (Legal Business Name): EMMA KEADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 ADAMS GRV STE 101
COLUMBIA SC
29203-6957
US

IV. Provider business mailing address

107 CHISWICK CT
IRMO SC
29063-2135
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-0531
  • Fax:
Mailing address:
  • Phone: 860-682-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW012225
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16959
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: