Individual
MR. MALCOLM AUGUSTIN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
999 WATERSIDE DR, 2525&2600, NORFOLK, VA 23510-3300
(757) 237-2185
Mailing address
999 WATERSIDE DR, 2525&2600, NORFOLK, VA 23510-3300
(757) 237-2185
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
916318
VA
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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