Basic Information
| Provider Information | |||||||||
| NPI: | 1003258930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | CHARANDLE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JORDAN | ||||||||
| OtherFirstName: | CHARANDLE | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4315 HIGHWAY 39 N APT 10K | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393011017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507753312 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1314 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393014116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014830011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A133826 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 890 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A133826 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 26465 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.