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1003258930

NPI Code Detail

MEDICARE: CHARANDLE S JORDAN MD

MEDICARE: CHARANDLE S JORDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A133826	CA
2	207R00000X	Internal Medicine Physician	890	GA
3	208M00000X	Hospitalist Physician	86891	GA
4	208M00000X	Hospitalist Physician	A133826	CA
5	207R00000X	Internal Medicine Physician	26465	MS

General Provider Information

NPI Number	:	1003258930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARANDLE S JORDAN MD

Provider Business Mailing Address
First Line	:	4315 HIGHWAY 39 N APT 10K
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-1017
Country	:	US
Telephone Number	:	650-775-3312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 19TH AVE
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-4116
Country	:	US
Telephone Number	:	601-483-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	01/20/2026

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Directions to “ CHARANDLE S JORDAN MD” Practice Location

Language	Start Address	Practice Location

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