Healthcare Provider Details

I. General information

NPI: 1740920495
Provider Name (Legal Business Name): JORDAN TWITCHELL SCHOUTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

PO BOX 3372
INDIANAPOLIS IN
46206-3372
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-7179
  • Fax:
Mailing address:
  • Phone: 866-254-3951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number111162
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: