Healthcare Provider Details

I. General information

NPI: 1609793082
Provider Name (Legal Business Name): JORDYN ANN EBERT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 NORTHSIDE DR STE 100
MACON GA
31210-2241
US

IV. Provider business mailing address

4705 NORTHSIDE DR STE 100
MACON GA
31210-2241
US

V. Phone/Fax

Practice location:
  • Phone: 478-207-6939
  • Fax:
Mailing address:
  • Phone: 478-207-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: