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General NPI Number Information
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NPI Number | 1639136997
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Entity Type | Individual
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Provider Name | TERRI GURROLA JORDAN PA-C, MPAS, APA
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Gender | Female
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 700 CENTER ST SUITE 102
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City | COLUMBUS
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State | GA
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Zip | 31901
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Country | US
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Telephone | 706-571-1011
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Fax | 706-320-8646
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Provider Business Mailing Address
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Address Line | 7901 VETERANS PKWY
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City | COLUMBUS
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State | GA
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Zip | 31909-1723
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Country | US
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Telephone | 706-321-1223
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Fax | 706-321-0819
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003981
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License Number State | GA
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