Provider Demographics
NPI:1194821850
Name:JORDAN, THOMAS M (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1285 UPPER HEMBREE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1143
Mailing Address - Country:US
Mailing Address - Phone:770-343-8565
Mailing Address - Fax:770-343-8651
Practice Address - Street 1:1285 UPPER HEMBREE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1143
Practice Address - Country:US
Practice Address - Phone:770-343-8565
Practice Address - Fax:770-343-8651
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30329207RC0000X
GA030329207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00395568BMedicaid
GA060029873OtherMEDICARE RAILROAD
GAE19515Medicare UPIN
GA00395568BMedicaid