Provider Demographics
NPI:1821198458
Name:JORDAN, JAMES EDWARD I (PHARMD, CDM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:JORDAN
Suffix:I
Gender:M
Credentials:PHARMD, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-3528
Mailing Address - Country:US
Mailing Address - Phone:912-632-8925
Mailing Address - Fax:912-632-2127
Practice Address - Street 1:905 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-3528
Practice Address - Country:US
Practice Address - Phone:912-632-8925
Practice Address - Fax:912-632-2127
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist