# QUINCY JORDAN MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972851384
- **Authorized official:** DR. QUINCY J JORDAN MD (OWNER)
- **Authorized official phone:** (877) 610-2791

## Contact information

- **Practice address:** 2350 SOUTH HOUSTON LAKE RD, \#902, KATHLEEN, GA 31047-5414
- **Practice address phone:** (877) 610-2791
- **Mailing address:** PO BOX 2105, FORT VALLEY, GA 31030-2105
- **Mailing address phone:** (877) 610-2791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 033367 | GA | Yes |

## Other

- **Enumeration date:** 08/16/2012
- **Last updated:** 09/04/2012