Provider Demographics
NPI:1225032741
Name:JORDAN, GINA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:Y
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:Y
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:27 KEMMERLIN LANE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-3402
Mailing Address - Country:US
Mailing Address - Phone:843-524-2100
Mailing Address - Fax:843-525-9613
Practice Address - Street 1:27 KEMMERLIN LANE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-3402
Practice Address - Country:US
Practice Address - Phone:843-524-2100
Practice Address - Fax:843-525-9613
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24049207R00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
57 1060903OtherTAX ID
SCGP1566Medicaid
SCGP1566Medicaid
SC7077Medicare ID - Type Unspecified