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Individual
JORDAN C SMITH
Active
Individual
JORDAN C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3880
SC
363AM0700X
Medical Physician Assistant
3664
TN
363AS0400X
Surgical Physician Assistant
3664
TN
Other
Enumeration date
07/18/2018
Last updated
09/03/2021
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