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NPI Code Detail

MEDICARE: KELLY JORDAN SPENCE MD

MEDICARE: KELLY JORDAN SPENCE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician86234SC
2207R00000XInternal Medicine Physician86234SC

General Provider Information

NPI Number : 1306421987
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JORDAN SPENCE MD
Provider Business Mailing Address
First Line : 300 E MCBEE AVE STE 300
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2899
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 200 N NELSON DR
Second Line :
City : FOUNTAIN INN
State : SC
Zip : 29644-9021
Country : US
Telephone Number : 864-522-6270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2021
Last Update Date : 11/18/2025

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Directions to “ KELLY JORDAN SPENCE MD” Practice Location

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