Healthcare Provider Details

I. General information

NPI: 1447209663
Provider Name (Legal Business Name): PATRICK MICHAEL JORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GREENWOOD DR SUITE C
HILTON HEAD SC
29928-4538
US

IV. Provider business mailing address

PO BOX 3406
BLUFFTON SC
29910-3406
US

V. Phone/Fax

Practice location:
  • Phone: 843-341-3232
  • Fax: 843-341-3234
Mailing address:
  • Phone: 843-341-3232
  • Fax: 843-341-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14780
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14780
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: