Healthcare Provider Details

I. General information

NPI: 1609003151
Provider Name (Legal Business Name): KELLY SUE GARITY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BLARNEY DR
COLUMBIA SC
29223-6244
US

IV. Provider business mailing address

109 BLARNEY DR
COLUMBIA SC
29223-6244
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-8200
  • Fax:
Mailing address:
  • Phone: 803-856-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: