Provider Demographics
NPI:1629619689
Name:JORDAN-PHILLIPS, SONJA
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:JORDAN-PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525-4221
Mailing Address - Country:US
Mailing Address - Phone:704-426-7667
Mailing Address - Fax:
Practice Address - Street 1:5330 TERRY RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525-4221
Practice Address - Country:US
Practice Address - Phone:704-426-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374U00000XNursing Service Related ProvidersHome Health Aide