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General NPI Number Information
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NPI Number | 1982893137
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Entity Type | Individual
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Provider Name | SANDRA KAY JORDAN R.D., LDN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 400 PEARMAN DAIRY RD
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City | ANDERSON
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State | SC
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Zip | 29625-3100
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Country | US
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Telephone | 864-260-5030
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Fax | 864-260-5074
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Provider Business Mailing Address
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Address Line | 303 W NORTH AVE
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City | ANDERSON
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State | SC
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Zip | 29625-2945
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Country | US
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Telephone | 864-224-4280
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Fax | 864-260-5074
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | LD002421
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | R518238
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License Number State | SC
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