Provider Demographics
NPI:1417958265
Name:JEWELL, JOHN N (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:JEWELL
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:PO BOX 277700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7700
Mailing Address - Country:US
Mailing Address - Phone:440-717-6600
Mailing Address - Fax:440-546-8381
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-7025
Practice Address - Fax:864-560-7388
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01133207P00000X
SC31469207P00000X
OH35.082052207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2378663Medicaid
MI4685180Medicaid
NC5905296Medicaid
OH000000353335OtherANTHEM
NC143KCOtherBCBS OF NC PROVIDER NUMBE
SC314699Medicaid
SC314699Medicaid
SCAA34738510Medicare PIN
NC143KCOtherBCBS OF NC PROVIDER NUMBE
NC5905296Medicaid
SCAA34739068Medicare PIN