Jordan Sparks, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

11552 Issued in GA

Practice address

3007 2ND St SE
Moultrie, GA 31768-6798

Phone

(229) 891-3325

Fax

(229) 890-8702

NPI assigned

Apr 11, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear, Nose, and Throat Clinic of Coffee Co.Group PAC ID 4486698578, 11 clinicians

Colquitt Regional Ear Nose and ThroatGroup PAC ID 2264741941, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tift Regional Medical Center Hospital, Tifton, GA, CCN 110095

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11118/brand/5/csg/22/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colquitt Regional Ear Nose & Throat

  • Otolaryngology Physician
  • Moultrie, GA
  • NPI 1477939833

  GA

  Medicare reassignment Care Compare group
• Ear, Nose and Throat Clinic of Coffee Co.

  • Specialist
  • Douglas, GA
  • NPI 1891750774

  GA

  Medicare reassignment Care Compare group
• Valdosta Orthopedic Associates PC

  • Orthopaedic Surgery Physician
  • Valdosta, GA
  • NPI 1053457457

  GA

  Medicare reassignment
• Westside Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Douglas, GA
  • NPI 1013158948
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tift Regional Health System Inc.

  • General Acute Care Hospital
  • Tifton, GA
  • NPI 1962462226

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1245925544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-891-3325",
            "fax_number": "229-890-8702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 2ND ST SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686798",
            "telephone_number": "229-891-3325",
            "fax_number": "229-890-8702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-11",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "GA",
            "license": "11552",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "11552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Georgia Pharmacy Services Inc
• Southeastern Urogynecology & Pelvic Surgery LLC
• Southern Orthodontics
• Southern Pelvic Therapy LLC
• Southwestern State Hospital
• Special Healthcare Solutions
• Robert O Spruill, MD
• Tracy Dale Stanley, CRNA
• Robert Timothy Stark, MD
• Carroll Curt Starling, MD

• All providers in Moultrie, GA
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.