Individual
MELISSA CLARK JANSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 GROVE RD, ER ADMINISTRATION, GREENVILLE, SC 29605-5611
(864) 455-6372
(864) 455-1130
Mailing address
1 INDEPENDENCE PT, STE 212, GREENVILLE, SC 29615-4545
(864) 797-6306
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21164
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20028605
SELECT HEALTH
SC
05
—
211648
—
SC
01
—
57-6007863
TRICARE
SC
Enumeration date
09/17/2006
Last updated
03/07/2023
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