Individual
JORDAN BOTHWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(495) 170-6721
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(495) 170-6721
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17514
GA
Other
Enumeration date
05/07/2025
Last updated
06/25/2025
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