Provider Demographics
NPI:1487198925
Name:SALADINO, JORDAN LEE GALLIMORE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:LEE GALLIMORE
Last Name:SALADINO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:SALADINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9057 HIGHBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1440
Mailing Address - Country:US
Mailing Address - Phone:865-805-2445
Mailing Address - Fax:
Practice Address - Street 1:288 S RIDGECREST ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2838
Practice Address - Country:US
Practice Address - Phone:865-805-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant