Provider Demographics
NPI:1275002560
Name:WHITEHEAD, JORDAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N COBB ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2348
Mailing Address - Country:US
Mailing Address - Phone:478-452-1222
Mailing Address - Fax:
Practice Address - Street 1:650 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2348
Practice Address - Country:US
Practice Address - Phone:478-452-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist