Provider Demographics
NPI:1881399897
Name:JORDAN, JADA BREYLE
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:BREYLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MILL LN
Mailing Address - Street 2:
Mailing Address - City:TENNILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31089-4308
Mailing Address - Country:US
Mailing Address - Phone:478-232-2106
Mailing Address - Fax:
Practice Address - Street 1:207 MILL LN
Practice Address - Street 2:
Practice Address - City:TENNILLE
Practice Address - State:GA
Practice Address - Zip Code:31089-4308
Practice Address - Country:US
Practice Address - Phone:478-232-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker