Provider Information for 1518480219
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MIRANDA L JORDAN MS
Sex: Female
NPI: 1518480219
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1518480219 | ||||||||
| Enumeration Date | 2017-07-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1316 SOMERVILLE RD SE STE 1 DECATUR, AL 35601-4309 United States Phone: 256-260-7361 | Fax:256-341-0747 | ||||||||
| Primary Practice Address | 295 HOSPITAL ST MOULTON, AL 35650-1210 United States Phone: 256-974-6697 | Fax:256-341-0747 | ||||||||
| Secondary Practice Address(es) | 4110 HIGHWAY 31 SOUTH | ||||||||
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