Provider Demographics
NPI:1154828796
Name:SHIRLEY, JORDAN J (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:J
Last Name:SHIRLEY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 HUNT CLUB BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-814-4600
Mailing Address - Fax:615-814-4606
Practice Address - Street 1:1531 HUNT CLUB BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-814-4600
Practice Address - Fax:615-814-4606
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4331208M00000X, 207Q00000X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty