Individual
LOUIS COLLIER JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2428 KNOB CREEK RD, SUITE 201, JOHNSON CITY, TN 37604-2397
(423) 282-5054
(423) 283-0516
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
11556
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005867975
—
VA
01
—
320315
ANTHEM
VA
05
—
3373123
—
TN
01
—
4017303
BCBS
TN
05
—
89014AT
—
NC
05
—
890564P
—
NC
01
—
TN0103
JDH
TN
Enumeration date
08/30/2006
Last updated
12/03/2014
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