Healthcare Provider Details

I. General information

NPI: 1295938801
Provider Name (Legal Business Name): KAREN ADAMS MOODY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2007
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 TAYLOR STREET
COLUMBIA SC
29220-0001
US

IV. Provider business mailing address

411 CLUB ACRES BLVD
ORANGEBURG SC
29118-4117
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-5010
  • Fax: 803-268-9680
Mailing address:
  • Phone: 803-268-9680
  • Fax: 803-268-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1999
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: