Provider Demographics
NPI:1275502536
Name:JORDAN, AMY YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:YOUNG
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2704 SAINT JUDE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3670
Mailing Address - Country:US
Mailing Address - Phone:336-954-7546
Mailing Address - Fax:336-235-4018
Practice Address - Street 1:2704 SAINT JUDE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3670
Practice Address - Country:US
Practice Address - Phone:336-954-7546
Practice Address - Fax:336-235-4018
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200555207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131MFMedicaid
NC89131MFMedicaid
NCH67731Medicare UPIN