Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 26465 | MS |
Y | 111NI0900X | Internist | 26465 | MS |
N | 207R00000X | Internist | 890 | GA |
N | 111NI0900X | Internist | 890 | GA |
N | 207R00000X | Internist | A133826 | CA |
N | 111NI0900X | Internist | A133826 | CA |
NPI | 1003258930 |
---|---|
Provider Name | Charandle S Jordan |
First Address | Meridian, MS 39301-1017 |
Second Address | Meridian, MS 39301-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 07/08/2020 |