Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 56725 | GA |
Y | 208600000X | Surgeon | 56725 | GA |
NPI | 1023007499 |
---|---|
Provider Name | Dr. Madhavi Jordan |
First Address | Marietta, GA 30060-1155 |
Second Address | Marietta, GA 30060-1155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 26/02/2021 |