Healthcare Provider Details

I. General information

NPI: 1851741789
Provider Name (Legal Business Name): JORDAN CIURO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 03/11/2024
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 LANEY WALKER BLVD
AUGUSTA GA
30912-1538
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6744
  • Fax:
Mailing address:
  • Phone: 706-721-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number90091
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBTLS483
License Number StateZZ
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number90091
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: