Healthcare Provider Details

I. General information

NPI: 1053314609
Provider Name (Legal Business Name): SHERYL GILLIKIN JORDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MEDICAL DR
FAYETTEVILLE NC
28304-4425
US

IV. Provider business mailing address

1301 MEDICAL DR
FAYETTEVILLE NC
28304-4425
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5700
  • Fax: 910-486-5950
Mailing address:
  • Phone: 910-486-5700
  • Fax: 910-486-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101282921
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number32320
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: