Provider Demographics
NPI:1942900394
Name:HARDIN, JORDAN TAYLOR (NP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:TAYLOR
Last Name:HARDIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 THE FARM RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-5642
Mailing Address - Country:US
Mailing Address - Phone:678-588-6587
Mailing Address - Fax:
Practice Address - Street 1:1631 HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7311
Practice Address - Country:US
Practice Address - Phone:770-288-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty