Healthcare Provider Details

I. General information

NPI: 1962252270
Provider Name (Legal Business Name): JOEL GRADY KEEFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9267 MEDICAL PLAZA DR STE G
NORTH CHARLESTON SC
29406-9139
US

IV. Provider business mailing address

9267 MEDICAL PLAZA DR STE G
NORTH CHARLESTON SC
29406-9139
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3636
  • Fax: 843-797-3637
Mailing address:
  • Phone: 843-797-3636
  • Fax: 843-797-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number97619
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: