Provider Demographics
NPI:1427257682
Name:GEARHART, SHANNON LEIGH (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:GEARHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6930
Mailing Address - Country:US
Mailing Address - Phone:803-434-6116
Mailing Address - Fax:803-434-7529
Practice Address - Street 1:3209 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6930
Practice Address - Country:US
Practice Address - Phone:803-434-6116
Practice Address - Fax:803-434-7529
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL29754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine