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General NPI Number Information
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NPI Number | 1811619000
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Entity Type | Individual
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Provider Name | JORDAN LEE
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Gender | Male
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 2215 DECATUR HWY STE 117
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City | GARDENDALE
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State | AL
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Zip | 35071-2384
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Country | US
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Telephone | 205-971-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 502 20TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2028
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-159934
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License Number State | AL
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