Healthcare Provider Details

I. General information

NPI: 1154828796
Provider Name (Legal Business Name): JORDAN J. SHIRLEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SAINT BLAISE RD STE 200
GALLATIN TN
37066-4594
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-230-8070
  • Fax:
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4331
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4331
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: