Healthcare Provider Details

I. General information

NPI: 1700990827
Provider Name (Legal Business Name): LEAH LANE SHUTT SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LEAH LANE SHUTT

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 SUNSET BLVD
LEXINGTON SC
29072-9250
US

IV. Provider business mailing address

601 CLEMSON RD
COLUMBIA SC
29229-4341
US

V. Phone/Fax

Practice location:
  • Phone: 803-520-5144
  • Fax: 803-462-0312
Mailing address:
  • Phone: 803-788-6146
  • Fax: 803-462-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200600241
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30653
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: