Provider Demographics
NPI:1366831067
Name:ANDREWS, JORDAN MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 PINEDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2101
Mailing Address - Country:US
Mailing Address - Phone:704-292-5668
Mailing Address - Fax:
Practice Address - Street 1:4843 PINEDALE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2101
Practice Address - Country:US
Practice Address - Phone:704-292-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant