Provider Demographics
NPI:1275572471
Name:JORDAN, COVIN MCKINLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:COVIN
Middle Name:MCKINLEY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:791 WALNUT KNOLL LN
Mailing Address - Street 2:2ND FL
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8839
Mailing Address - Country:US
Mailing Address - Phone:901-755-7001
Mailing Address - Fax:901-753-2896
Practice Address - Street 1:2301 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5373
Practice Address - Country:US
Practice Address - Phone:662-232-8100
Practice Address - Fax:901-753-2896
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS066482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS115759Medicaid
MSB30242Medicare UPIN