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General NPI Number Information
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NPI Number | 1003258930
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Entity Type | Individual
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Provider Name | CHARANDLE S JORDAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 1314 19TH AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-4116
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Country | US
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Telephone | 601-483-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 4315 HIGHWAY 39 N APT 10K
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City | MERIDIAN
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State | MS
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Zip | 39301-1017
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Country | US
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Telephone | 650-775-3312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A133826
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 890
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A133826
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 26465
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License Number State | MS
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