Provider Demographics
NPI:1548288780
Name:HOWARD DRADDY, CARLEY MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:MICHELLE
Last Name:HOWARD DRADDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:MICHELLE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:175 PATEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3570
Practice Address - Country:US
Practice Address - Phone:864-797-1403
Practice Address - Fax:864-455-3884
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27927208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279273Medicaid
SC279273Medicaid