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Individual

JORDAN LANE TRUBY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(770) 744-4809
Mailing address
600 CELEBRATE LIFE PARKWAY, NEWNAN, GA 30265
(770) 744-4809

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
924764
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
145632
GA

Other

Enumeration date
07/05/2023
Last updated
08/22/2023
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