Individual
JACK WILSON CLELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1330 BOILING SPRINGS RD, SUITE 1300, SPARTANBURG, SC 29303-4201
(864) 560-6345
(864) 560-6054
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
30778
SC
208000000X
Pediatrics Physician
LL30778
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307787
—
SC
Enumeration date
06/02/2008
Last updated
12/11/2020
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