Healthcare Provider Details

I. General information

NPI: 1588684104
Provider Name (Legal Business Name): JEFFREY SCOTT JORDAN MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 RAYMOND HIRSCH PKWY
WHITE HOUSE TN
37188-8193
US

IV. Provider business mailing address

PO BOX 1669
WHITE HOUSE TN
37188-1669
US

V. Phone/Fax

Practice location:
  • Phone: 615-672-7122
  • Fax: 615-672-8122
Mailing address:
  • Phone: 615-672-7122
  • Fax: 615-672-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD36092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: