Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 200200929 | NC |
NPI | 1023197126 |
---|---|
Provider Name | George Lee Jordan III |
First Address | Greenville, NC 27833-0750 |
Second Address | Greenville, NC 27834-5758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132A8 | BCBS (01) | NC |
89132A8 | (05) | NC |
H62596 | (02) |