Healthcare Provider Details

I. General information

NPI: 1619814803
Provider Name (Legal Business Name): JORDAN CROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 RIVERVIEW RD APT 1132
BIRMINGHAM AL
35242-4762
US

IV. Provider business mailing address

2800 RIVERVIEW RD APT 1132
BIRMINGHAM AL
35242-4762
US

V. Phone/Fax

Practice location:
  • Phone: 205-410-6226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6548C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: