Individual
ROBERT JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8954 HOSPITAL DR, DOUGLASVILLE, GA 30134
(770) 920-6420
Mailing address
5665 NEW NORTHSIDE DR NW, ATLANTA, GA 30328-5831
(770) 874-5400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
001968
GA
363A00000X
Physician Assistant
Primary
001968
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
GA
Enumeration date
09/26/2006
Last updated
09/04/2018
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