Individual
MR. CLIFTON ANTHONY JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASTER BARBER
Contact information
Practice address
1106 EAST AVE SUITE J, CORDELE, GA 31015
(229) 406-0499
Mailing address
215 W 27TH AVE, CORDELE, GA 31015-3854
(229) 406-0499
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
GA
335E00000X
Prosthetic/Orthotic Supplier
BR019994
GA
Other
Enumeration date
05/08/2019
Last updated
06/22/2020
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