Healthcare Provider Details

I. General information

NPI: 1134654494
Provider Name (Legal Business Name): CANNADY AGENCY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E WASHINGTON ST
WALTERBORO SC
29488-3919
US

IV. Provider business mailing address

305 E WASHINGTON ST
WALTERBORO SC
29488-3919
US

V. Phone/Fax

Practice location:
  • Phone: 843-549-1846
  • Fax: 843-549-6628
Mailing address:
  • Phone: 843-549-1846
  • Fax: 843-549-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number224240
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number224240
License Number StateSC

VIII. Authorized Official

Name: MS. MARY ANNE CANNADY
Title or Position: CHAIRMAN
Credential:
Phone: 843-549-1846