Healthcare Provider Details

I. General information

NPI: 1194222935
Provider Name (Legal Business Name): JORDAN CAITLIN POLK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 PONDER PLACE DR
EVANS GA
30809-3186
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 762-224-3027
  • Fax: 762-208-4742
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP001161
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21658
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: