=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982662896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JORDAN & ASSOCIATES GASTROENTEROLOGY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 649 GUY RD STE 200
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-938-4404
-----------------------------------------------------
Fax | 919-938-3055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 649 GUY RD STE 200
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-938-4404
-----------------------------------------------------
Fax | 919-938-3055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CHRISTOPHER PAGE JORDAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 919-938-4404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 200000842
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------