Provider Demographics
NPI:1770534893
Name:JORDAN, HENRY S JR (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:SPEIR
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602573
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2573
Mailing Address - Country:US
Mailing Address - Phone:864-427-4081
Mailing Address - Fax:864-427-8733
Practice Address - Street 1:323 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2838
Practice Address - Country:US
Practice Address - Phone:864-427-6058
Practice Address - Fax:864-427-6059
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014518207P00000X
SC6770208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC67705Medicaid
D99328Medicare UPIN
SC9159Medicare PIN