Individual
MICAH JORDAN ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 E WOOD ST, EMERGENCY DEPARTMENT, SPARTANBURG, SC 29303-3040
(864) 560-2222
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
27275
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189217
MEDCOST
SC
01
—
20051879
SELECT HEALTH
SC
05
—
272751
—
SC
05
—
89067H6
—
NC
01
—
AA06278510
MEDICARE PIN
SC
01
—
AA06279068
MEDICARE PIN
SC
Enumeration date
01/18/2006
Last updated
10/14/2023
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