Healthcare Provider Details

I. General information

NPI: 1942900394
Provider Name (Legal Business Name): JORDAN TAYLOR HARDIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HIGHWAY 20 W
MCDONOUGH GA
30253-7311
US

IV. Provider business mailing address

PO BOX 746765
ATLANTA GA
30374-6765
US

V. Phone/Fax

Practice location:
  • Phone: 770-288-2822
  • Fax:
Mailing address:
  • Phone: 770-914-0116
  • Fax: 770-995-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP239481
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: