Healthcare Provider Details

I. General information

NPI: 1093636524
Provider Name (Legal Business Name): JORDAN HOLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 AUBURN AVE STE 1208A
COLUMBUS GA
31906-1708
US

IV. Provider business mailing address

2012 AUBURN AVE STE 1208A
COLUMBUS GA
31906-1708
US

V. Phone/Fax

Practice location:
  • Phone: 205-440-2992
  • Fax:
Mailing address:
  • Phone: 205-440-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA005526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: