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General NPI Number Information
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NPI Number | 1588155980
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Entity Type | Organization
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Legal Business Name | MICHAEL JORDAN SERVICES, LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 232 POWELL RD
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City | RIDGELAND
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State | MS
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Zip | 39157-5071
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Country | US
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Telephone | 601-898-4429
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Fax | 601-898-4431
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Provider Business Mailing Address
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Address Line | 232 POWELL RD
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City | RIDGELAND
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State | MS
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Zip | 39157-5071
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Country | US
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Telephone | 601-898-4429
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Fax | 601-898-4431
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL JORDAN SR.
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Credential |
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Telephone | 601-898-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | 801623013
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License Number State | MS
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