Provider Demographics
NPI:1124064738
Name:JORDAN, HARRY A (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARRY
Other - Middle Name:ALTON
Other - Last Name:JORDAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1295 WILSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1804
Mailing Address - Country:US
Mailing Address - Phone:803-905-6800
Mailing Address - Fax:803-905-6810
Practice Address - Street 1:1295 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1804
Practice Address - Country:US
Practice Address - Phone:803-905-6800
Practice Address - Fax:803-905-6810
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2526Medicaid
SCF877026364Medicare PIN
SCF87702Medicare UPIN