Provider Demographics
NPI:1508008079
Name:TATE, JORDAN LEE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:TATE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 28415
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2036
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1101 OLD PHILADELPHIA RD STE G
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4069
Practice Address - Country:US
Practice Address - Phone:678-971-4167
Practice Address - Fax:833-989-2501
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASTUDENT207R00000X
GA0039162081P2900X
FLME115895208VP0000X
GA72139208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150702Medicaid
202I250319Medicare PIN