Provider Demographics
NPI:1003494915
Name:HERRIN, WILLIAM JORDAN
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JORDAN
Last Name:HERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6965 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5455
Mailing Address - Country:US
Mailing Address - Phone:678-488-4056
Mailing Address - Fax:
Practice Address - Street 1:6965 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5455
Practice Address - Country:US
Practice Address - Phone:678-488-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker