Healthcare Provider Details

I. General information

NPI: 1962322560
Provider Name (Legal Business Name): JORDAN ANNE LOGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 THOMPSON BRIDGE RD
GAINESVILLE GA
30501-1129
US

IV. Provider business mailing address

6210 YORKTOWN CT
FLOWERY BRANCH GA
30542-5638
US

V. Phone/Fax

Practice location:
  • Phone: 470-208-2903
  • Fax:
Mailing address:
  • Phone: 678-997-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017059
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: