Healthcare Provider Details

I. General information

NPI: 1902078066
Provider Name (Legal Business Name): JORDAN CHRISTOPHER SMALLWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MCDOWELL ST
ASHEVILLE NC
28801-4104
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-3749
  • Fax: 828-254-9925
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME 116755
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2022-02522
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: