Provider Demographics
NPI:1265271332
Name:JORDAN, CANDICE PATRICE NICOLE (RRT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:PATRICE NICOLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-8339
Mailing Address - Country:US
Mailing Address - Phone:912-424-2219
Mailing Address - Fax:
Practice Address - Street 1:319 GENERAL SCREVEN WAY
Practice Address - Street 2:SUITE D2 OFFICE 105
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-424-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy