Healthcare Provider Details

I. General information

NPI: 1952365413
Provider Name (Legal Business Name): JOHN L EADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD SUITE 404
COLUMBIA SC
29203-6808
US

IV. Provider business mailing address

15 MEDICAL PARK RD SUITE 300
COLUMBIA SC
29203-8003
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6812
  • Fax: 803-255-3451
Mailing address:
  • Phone: 803-255-3417
  • Fax: 803-255-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5196
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: