Individual
DR. SHANNON ROSE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
325 FOLLY RD STE 102A, CHARLESTON, SC 29412-2507
(843) 762-1440
(843) 762-6979
Mailing address
PO BOX 632516, CINCINNATI, OH 45263-2516
(888) 472-0043
(513) 653-4122
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36707
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
367070
—
SC
Enumeration date
06/11/2014
Last updated
04/15/2026
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