Provider Demographics
NPI:1003865346
Name:ORDONEZ, JORGE ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ENRIQUE
Last Name:ORDONEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:1032 MCCALLIE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2800
Practice Address - Country:US
Practice Address - Phone:423-266-4588
Practice Address - Fax:865-342-0103
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14915174400000X
TNMD14915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0152247OtherBLUE CROSS BLUE SHIELD
GA00341382BMedicaid
TN14915OtherMEDICAL LICENSE
GA024611OtherGEORGIA MEDICAL LICENSE
GA024611OtherGEORGIA MEDICAL LICENSE
TN14915OtherMEDICAL LICENSE