Provider Demographics
NPI:1710462114
Name:JORDAN, LINDSEY L (MS RD LD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6073 LUKE RD
Mailing Address - Street 2:
Mailing Address - City:RAY CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31645-2119
Mailing Address - Country:US
Mailing Address - Phone:706-415-7249
Mailing Address - Fax:
Practice Address - Street 1:6073 LUKE RD
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-2119
Practice Address - Country:US
Practice Address - Phone:706-415-7249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered