1477938314 NPI number — MR. DANIEL W. JORDAN LADAC II, CADC II

Table of content: MR. DANIEL W. JORDAN LADAC II, CADC II (NPI 1477938314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477938314 NPI number — MR. DANIEL W. JORDAN LADAC II, CADC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN
Provider First Name:
DANIEL
Provider Middle Name:
W.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LADAC II, CADC II
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JORDAN
Provider Other First Name:
DANIEL
Provider Other Middle Name:
W.
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477938314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
822 CHICKAMAUGA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30741-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-861-6458
Provider Business Mailing Address Fax Number:
706-866-6277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
822 CHICKAMAUGA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30741-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-861-6458
Provider Business Practice Location Address Fax Number:
706-866-6277
Provider Enumeration Date:
07/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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