Healthcare Provider Details

I. General information

NPI: 1821876541
Provider Name (Legal Business Name): JORDAN BROOKE SCHAEFFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW STE 775
ATLANTA GA
30309-1608
US

IV. Provider business mailing address

35 COLLIER RD NW STE 775
ATLANTA GA
30309-1608
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11959
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: