Individual
QUENTIN TYLER SMALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9300 MEDICAL PLAZA DR STE B, CHARLESTON, SC 29406-9334
(843) 764-1730
Mailing address
9300 MEDICAL PLAZA DR STE B, CHARLESTON, SC 29406-9334
(843) 764-1730
(843) 764-1731
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3866
SC
363AS0400X
Surgical Physician Assistant
3866
SC
Other
Enumeration date
01/19/2021
Last updated
03/10/2021
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