Provider Demographics
NPI:1700990827
Name:SMITH, LEAH LANE SHUTT (MD)
Entity type:Individual
Prefix:DR
First Name:LEAH LANE
Middle Name:SHUTT
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:LANE
Other - Last Name:SHUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4341
Mailing Address - Country:US
Mailing Address - Phone:803-788-6146
Mailing Address - Fax:803-462-0312
Practice Address - Street 1:4568 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9250
Practice Address - Country:US
Practice Address - Phone:803-520-5144
Practice Address - Fax:803-462-0312
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600241208000000X
SC30653208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS9808354OtherDEA