Individual
RANDALL G. JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1841 HONEYSUCKLE RD, DOTHAN, AL 36305-4269
(334) 794-2113
(334) 702-1220
Mailing address
1841 HONEYSUCKLE RD, DOTHAN, AL 36305-4269
(334) 794-2113
(334) 702-1220
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
634
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104596
—
AL
Enumeration date
10/31/2005
Last updated
03/12/2009
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