Provider Demographics
NPI:1609873488
Name:MCCLANAHAN, JAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:T
Last Name:MCCLANAHAN
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 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 BAPTIST BLVD.
Practice Address - Street 2:SUITE 407
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2004
Practice Address - Country:US
Practice Address - Phone:662-241-4223
Practice Address - Fax:662-241-4460
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19458208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03730025Medicaid
MS03730025Medicaid
MS302I028816Medicare PIN
MS03730025Medicaid
MS302I028816Medicare PIN
B64553Medicare UPIN
LA020010962OtherRAILROAD MEDICARE ID
MS03730025Medicaid
LAB64553Medicare UPIN
MS302I028816Medicare PIN