| Doctor Name: | TINA JORDAN |
| NPI Number: | 1255703088 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | RN 98431 |
| Business Practice Address: | 101 Deluxe Cir Suite B Thomaston, GA - 302863030 |
| Business Phone Number: | 7066477509 |
| Business Fax Number: | 7066476624 |
| Mailing Address: | 600 Highpoint Way, MCDONOUGH |
| State: | GA |
| Postal Code: | 302534699 |
| Phone Number: | 4046068430 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2015 |
| NPI Last Update Date: | 12/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN 98431 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |