Provider Demographics
NPI:1043962566
Name:JORDAN, RAMEKIA N
Entity type:Individual
Prefix:
First Name:RAMEKIA
Middle Name:N
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 1:213 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:TENNILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31089-1442
Mailing Address - Country:US
Mailing Address - Phone:478-232-3039
Mailing Address - Fax:
Practice Address - Street 1:213 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:TENNILLE
Practice Address - State:GA
Practice Address - Zip Code:31089-1442
Practice Address - Country:US
Practice Address - Phone:478-232-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN072321164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse