Individual
DR. SHANNON SMITH TIEBOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3418 CASEY ST, LORIS, SC 29569-2904
(843) 756-7885
(843) 756-7855
Mailing address
3418 CASEY ST, LORIS, SC 29569-2904
(843) 756-7885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
82954
SC
Other
Enumeration date
07/14/2019
Last updated
12/19/2023
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