Individual
DR. JOHN EDGAR KLECKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3710 LANDMARK DR STE 408, COLUMBIA, SC 29204-4034
(803) 799-1922
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(436) 956-0718
(843) 569-5879
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
29749
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297495
—
SC
01
—
P00467100
RAILROAD MEDICARE PIN
SC
01
—
P00803393
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
06/08/2007
Last updated
11/22/2024
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