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General NPI Number Information
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NPI Number | 1053314609
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Entity Type | Individual
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Provider Name | SHERYL GILLIKIN JORDAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 1301 MEDICAL DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4425
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Country | US
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Telephone | 910-486-5700
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Fax | 910-486-5950
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Provider Business Mailing Address
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Address Line | 1301 MEDICAL DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4425
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Country | US
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Telephone | 910-486-5700
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Fax | 910-486-5950
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101282921
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 32320
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License Number State | NC
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