MEDICARE: DR. SHARON SNELL JORDAN D.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
1	1223G0001X	General Practice Dentistry	DN009686	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1316237688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON SNELL JORDAN D.M.D.

Provider Business Mailing Address
First Line	:	2614 CHEROKEE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-3924
Country	:	US
Telephone Number	:	678-230-6929
Fax Number	:	478-743-3583

Provider Business Practice Location Address
First Line	:	2614 CHEROKEE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-3924
Country	:	US
Telephone Number	:	478-743-3583
Fax Number	:	478-743-8847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	01/25/2015

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