Provider Demographics
NPI:1518763176
Name:STAMPER, JORDAN MACKENZIE (NP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MACKENZIE
Last Name:STAMPER
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 1:4084 ASHEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6902
Mailing Address - Country:US
Mailing Address - Phone:678-772-1608
Mailing Address - Fax:
Practice Address - Street 1:631 PROFESSIONAL DR STE 360
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3370
Practice Address - Country:US
Practice Address - Phone:678-312-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2024094678363LA2100X
GARN295277363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care