Healthcare Provider Details

I. General information

NPI: 1902622442
Provider Name (Legal Business Name): JORDAN POUNDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 TURNER MCCALL BLVD NE
ROME GA
30165-2735
US

IV. Provider business mailing address

475 TURNER MCCALL BLVD NE
ROME GA
30165-2735
US

V. Phone/Fax

Practice location:
  • Phone: 706-368-8894
  • Fax: 706-368-8894
Mailing address:
  • Phone: 706-368-8894
  • Fax: 706-368-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: