MEDICARE: JORDAN MICHELLE WILLIAMS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator	NC
2	390200000X	Student in an Organized Health Care Education/Training Program	NC
3	106S00000X	Behavior Technician	NC

General Provider Information

NPI Number	:	1316815806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MICHELLE WILLIAMS

Provider Business Mailing Address
First Line	:	1817 BREWTON DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2327
Country	:	US
Telephone Number	:	980-250-4583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 BREWTON DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2327
Country	:	US
Telephone Number	:	980-250-4583
Fax Number	:

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

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	10/27/2025

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Directions to “ JORDAN MICHELLE WILLIAMS ” Practice Location

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