Healthcare Provider Details

I. General information

NPI: 1417046327
Provider Name (Legal Business Name): TERRY T JORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HWY 39 NORTH
MERIDIAN MS
39301
US

IV. Provider business mailing address

5000 HIGHWAY 39 N
MERIDIAN MS
39301-1021
US

V. Phone/Fax

Practice location:
  • Phone: 601-482-2400
  • Fax: 601-485-2310
Mailing address:
  • Phone: 601-482-2400
  • Fax: 601-485-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14095
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: