Individual
SHANNON R POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D,
Contact information
Practice address
2 MEDICAL PARK RD STE 107, COLUMBIA, SC 29203-6839
(803) 545-5700
(803) 434-4699
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21999
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201212180
—
IN
05
—
T59932
—
SC
Enumeration date
08/25/2006
Last updated
03/20/2018
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