Provider Demographics
NPI:1740953082
Name:SMITH, JANELL GREEN
Entity type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:GREEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANELL
Other - Middle Name:ASHLYNN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:35 MEDICAL RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:864-797-7350
Mailing Address - Fax:
Practice Address - Street 1:35 MEDICAL RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4268
Practice Address - Country:US
Practice Address - Phone:864-797-7350
Practice Address - Fax:864-797-7355
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC176B00000X
SC25310367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGMedicaid