Quincy Jordan MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

033367 Issued in GA

Legal business name

QUINCY JORDAN MD LLC

Practice address

2350 South Houston Lake Rd
#902
Kathleen, GA 31047-5414

Phone

(877) 610-2791

NPI assigned

Aug 16, 2012

Last updated

Sep 4, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Quincy J Jordan, MD

Title

Owner

Phone

(877) 610-2791

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346716800000",
    "number": "1972851384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2105",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310302105",
            "telephone_number": "877-610-2791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 SOUTH HOUSTON LAKE RD",
            "address_2": "#902",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "310475414",
            "telephone_number": "877-610-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINCY JORDAN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-09-04",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "QUINCY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-610-2791",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "033367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Kathleen, GA
• Providers in Kathleen, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.