Healthcare Provider Details

I. General information

NPI: 1154025088
Provider Name (Legal Business Name): JORDAN CHRISTOPHER MAURY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 WESTCHESTER DR STE 301
HIGH POINT NC
27262-7369
US

IV. Provider business mailing address

1814 WESTCHESTER DR STE 301
HIGH POINT NC
27262-7369
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2025
  • Fax: 336-802-2026
Mailing address:
  • Phone: 336-802-2025
  • Fax: 336-802-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-04254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: