MEDICARE: KIMBERLY ELIZABETH 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	207Q00000X	Family Medicine Physician	105060	GA
2	207Q00000X	Family Medicine Physician	35-08-3111-J	OH
3	207Q00000X	Family Medicine Physician	2010-01703	NC

General Provider Information

NPI Number	:	1457315947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ELIZABETH JORDAN MD

Provider Business Mailing Address
First Line	:	1100 LAKE HEARN DR STE 450
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1524
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 LAKE HEARN DR STE 450
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1524
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/16/2025

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