Individual
JANET M MCKISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
333 REVOLUTIONARY TRL, FAIRFAX, SC 29827-7109
(803) 632-2533
(803) 632-2451
Mailing address
220 MANOR VIEW CT, COLUMBIA, SC 29212-2330
(803) 603-0758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13979
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13979
MEDICAL LICENSE
SC
05
—
139790
—
SC
Enumeration date
07/23/2006
Last updated
02/27/2023
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