Healthcare Provider Details

I. General information

NPI: 1740869031
Provider Name (Legal Business Name): JORDAN BEST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 J L WHITE DR STE 160
JASPER GA
30143-4895
US

IV. Provider business mailing address

1930 BRANNAN RD
MCDONOUGH GA
30253-4310
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-4384
  • Fax: 706-692-2504
Mailing address:
  • Phone: 678-284-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number111197
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: