Healthcare Provider Details

I. General information

NPI: 1710679733
Provider Name (Legal Business Name): JORDAN SUZANNE NOLAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N STE 255
CONCORD NC
28025-2927
US

IV. Provider business mailing address

920 CHURCH ST N STE 255
CONCORD NC
28025-2927
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-1331
  • Fax:
Mailing address:
  • Phone: 704-403-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-03367
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: