Provider Demographics
NPI:1629042189
Name:MCCALL, M JANE (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:JANE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 EAST WOOD ST
Practice Address - Street 2:EMERGENCY CENTER
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:2006-02-13
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC10535207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC105353Medicaid
SC7326192OtherAETNA
NC89065H5Medicaid
SC189213OtherMEDCOST
SC20006005OtherSELECT HEALTH
SCD182718510OtherMEDICARE PIN
SC105353Medicaid
SC20006005OtherSELECT HEALTH
SCD182718510Medicare PIN
SC189213OtherMEDCOST