Provider Demographics
NPI:1629153689
Name:JORDAN, DEBRA ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ELAINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ELAINE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:235 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-3564
Mailing Address - Country:US
Mailing Address - Phone:770-867-8007
Mailing Address - Fax:770-586-5489
Practice Address - Street 1:2739 FELTON DR
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3603
Practice Address - Country:US
Practice Address - Phone:404-766-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE95657Medicare UPIN