Individual
DR. JORDAN LEE TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., MPH
Contact information
Practice address
1101 OLD PHILADELPHIA RD STE G, JASPER, GA 30143-4069
(678) 971-4167
(833) 989-2501
Mailing address
PO BOX 28415, BELFAST, ME 04915-2036
(888) 488-8289
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
STUDENT
GA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
003916
GA
208VP0000X
Pain Medicine Physician
ME115895
FL
208VP0014X
Interventional Pain Medicine Physician
Primary
72139
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003150702
—
GA
Enumeration date
03/30/2009
Last updated
05/13/2022
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