Healthcare Provider Details

I. General information

NPI: 1679761613
Provider Name (Legal Business Name): TONYA JORDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309-1796
US

IV. Provider business mailing address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309-1796
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-7955
  • Fax: 404-350-9155
Mailing address:
  • Phone: 404-574-5820
  • Fax: 404-574-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number60282
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: