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Individual

AUTUMN JORDAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
3971 LEWISVILLE HIGH SCHOOL RD, RICHBURG, SC 29729-9029
(803) 246-9969
Mailing address
PO BOX 73, FORT LAWN, SC 29714-0073

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
09/04/2019
Last updated
09/04/2019
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