Individual
JORDAN DANIEL CLEVENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6114 BLUEWATER BLVD, GAINESVILLE, GA 30506-2560
(770) 355-7034
Mailing address
6114 BLUEWATER BLVD, GAINESVILLE, GA 30506-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1206279
GA
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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