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General NPI Number Information
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NPI Number | 1841020963
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Entity Type | Individual
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Provider Name | JORDAN STARR LOPEZ DIXON PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 1323 METROPOLITAN PKWY SW
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City | ATLANTA
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State | GA
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Zip | 30310-4441
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Country | US
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Telephone | 678-589-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 METROPOLITAN PKWY SW
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City | ATLANTA
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State | GA
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Zip | 30310-4441
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Country | US
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Telephone | 678-589-7546
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.2501
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12600
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License Number State | GA
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