Individual
JORDAN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3007 2ND ST SE, MOULTRIE, GA 31768-6798
(229) 891-3325
(229) 890-8702
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 891-3325
(229) 890-8702
Taxonomy
Speciality
Code
Description
License number
State
246ZX2200X
Orthopedic Assistant
11552
GA
363AM0700X
Medical Physician Assistant
Primary
11552
GA
Other
Enumeration date
04/11/2023
Last updated
03/05/2026
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