MEDICARE: RACHEL ELIZABETH JORDAN RN, IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	L-307436	GA
2	163WL0100X	Lactation Consultant (Registered Nurse)	RN286628	GA

General Provider Information

NPI Number	:	1407707599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ELIZABETH JORDAN RN, IBCLC

Provider Business Mailing Address
First Line	:	503 N HIGHLAND AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1430
Country	:	US
Telephone Number	:	404-948-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 N HIGHLAND AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1430
Country	:	US
Telephone Number	:	404-948-6773
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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