Individual
GRAYSON JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
21 S SHIRLEY AVE, HONEA PATH, SC 29654-1503
(864) 512-7879
(864) 512-7037
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-7879
(864) 512-7037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39787
SC
207Q00000X
Family Medicine Physician
LL39787
SC
Other
Enumeration date
06/16/2016
Last updated
01/05/2023
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