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NPI Code Detail

MEDICARE: DR. SHARON SNELL JORDAN D.M.D.

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
11223G0001XGeneral Practice DentistryDN009686GA

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 : 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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Directions to “ DR. SHARON SNELL JORDAN D.M.D.” Practice Location

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