Individual
MR. CHARLES RAYMOND JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1350 SUNSET DR STE B, GRENADA, MS 38901-4079
(662) 466-3632
Mailing address
PO BOX 395, N.CARROLLTON, MS 38947-0395
(662) 466-3632
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R869908
MS
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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