MEDICARE: SYDNEY 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	103K00000X	Behavior Analyst	1-23-68486

General Provider Information

NPI Number	:	1841763919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY JORDAN

Provider Business Mailing Address
First Line	:	220 RIVER ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-3654
Country	:	US
Telephone Number	:	229-495-3005
Fax Number	:	229-495-3018

Provider Business Practice Location Address
First Line	:	220 RIVER ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-3654
Country	:	US
Telephone Number	:	229-495-3005
Fax Number	:	229-495-3018

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	10/23/2023

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Directions to “ SYDNEY JORDAN ” Practice Location

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