Healthcare Provider Details

I. General information

NPI: 1033584859
Provider Name (Legal Business Name): JORDAN LOGGINS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 CLEVELAND HIGHWAY
CLERMONT GA
30527
US

IV. Provider business mailing address

837 SUMMER SPRINGS CT
PENDERGRASS GA
30567-4656
US

V. Phone/Fax

Practice location:
  • Phone: 770-983-2130
  • Fax:
Mailing address:
  • Phone: 678-936-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: