Provider Demographics
NPI:1467082743
Name:JORDAN, JOSEPH VINCENT (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VINCENT
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:713 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5808
Mailing Address - Country:US
Mailing Address - Phone:336-722-7266
Mailing Address - Fax:336-201-0538
Practice Address - Street 1:964 HIGH HOUSE RD UNIT 4037
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3574
Practice Address - Country:US
Practice Address - Phone:910-644-0887
Practice Address - Fax:949-862-3679
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2023-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110007263363A00000X
NC0010-12416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant