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NPI Code Detail

MEDICARE: DR. BRITON PENN JORDAN M.D.

MEDICARE: DR. BRITON PENN JORDAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician053467GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114916582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRITON PENN JORDAN M.D.
Provider Business Mailing Address
First Line : PO BOX 12938
Second Line : C/O CLINIC MANAGEMENT
City : CALHOUN
State : GA
Zip : 30703-7013
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1035 RED BUD RD NE STE 200
Second Line :
City : CALHOUN
State : GA
Zip : 30701-6010
Country : US
Telephone Number : 706-602-8300
Fax Number : 706-625-6955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 01/02/2020

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