MEDICARE: NICKEYA JORDAN

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	3747P1801X	Personal Care Attendant		GA
2	372600000X	Adult Companion

General Provider Information

NPI Number	:	1043194061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKEYA JORDAN

Provider Business Mailing Address
First Line	:	2073 ARBOR SPRINGS WAY
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-2287
Country	:	US
Telephone Number	:	404-667-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2073 ARBOR SPRINGS WAY
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-2287
Country	:	US
Telephone Number	:	404-667-0212
Fax Number	:

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

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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Directions to “ NICKEYA JORDAN ” Practice Location

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