Active NPI
Desiree Jordan
- Durable Medical Equipment & Medical Supplies
- Macon, GA
National Provider Identifier
1740093244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- COA010392
- Practice address
- 3872 Pio Nono Ave
Macon, GA 31206-3042 - Phone
- (478) 219-0968
- NPI assigned
- Jan 29, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | COA010392 | GA | Primary |
Addresses
Primary practice location
3872 Pio Nono Ave
Macon, GA 31206-3042
Mailing address
3900 Northside Dr, Macon, Ga 31210, USA
D15
Macon, GA 31210
Phone (478) 219-0968
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA010392 | GA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738108800000",
"number": "1740093244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 NORTHSIDE DR, MACON, GA 31210, USA",
"address_2": "D15",
"city": "MACON",
"state": "GA",
"postal_code": "31210",
"telephone_number": "478-219-0968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3872 PIO NONO AVE",
"city": "MACON",
"state": "GA",
"postal_code": "312063042",
"telephone_number": "478-219-0968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "DESIREE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-29",
"last_updated": "2025-01-29",
"certification_date": "2025-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "GA",
"license": "COA010392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.