Provider Demographics
NPI:1386250793
Name:SAPP, JORDAN ALEXANDER
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:ALEXANDER
Last Name:SAPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 BLEDSOE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-1904
Mailing Address - Country:US
Mailing Address - Phone:336-558-0910
Mailing Address - Fax:
Practice Address - Street 1:5606 BLEDSOE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-1904
Practice Address - Country:US
Practice Address - Phone:336-558-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician