Provider Demographics
NPI:1861461188
Name:TOLLISON, STEVEN BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRADLEY
Last Name:TOLLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:520 THURGOOD MARSHALL HWY STE B
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4108
Practice Address - Country:US
Practice Address - Phone:843-355-5628
Practice Address - Fax:843-355-5616
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC223001Medicaid
SCA16422Medicare UPIN