Healthcare Provider Details

I. General information

NPI: 1679799209
Provider Name (Legal Business Name): ANNA C KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E PALMETTO ST
FLORENCE SC
29506-2851
US

IV. Provider business mailing address

360 N IRBY ST
FLORENCE SC
29501-2808
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-9414
  • Fax: 843-407-9726
Mailing address:
  • Phone: 843-667-9414
  • Fax: 843-407-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number034624
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number69003
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number69003
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number22597
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: