Individual
STEPHANIE H TETTERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 408-3277
(803) 408-3282
Mailing address
PO BOX 520, LUGOFF, SC 29078-0520
(803) 408-3277
(803) 408-3282
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
860
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
860
—
SC
Enumeration date
08/03/2006
Last updated
09/22/2011
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