Healthcare Provider Details

I. General information

NPI: 1174125637
Provider Name (Legal Business Name): JORDAN R MURPHY PHD, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 BOULEVARD NE
ATLANTA GA
30312-1468
US

IV. Provider business mailing address

173 BOULEVARD NE
ATLANTA GA
30312-1468
US

V. Phone/Fax

Practice location:
  • Phone: 404-658-1500
  • Fax:
Mailing address:
  • Phone: 404-658-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN252467
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN252467
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN252467
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN252467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: