Provider Demographics
NPI:1871595637
Name:SHARON S JORDON PC
Entity type:Organization
Organization Name:SHARON S JORDON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:SNELL
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-763-3583
Mailing Address - Street 1:2614 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3924
Mailing Address - Country:US
Mailing Address - Phone:478-743-3583
Mailing Address - Fax:478-743-3398
Practice Address - Street 1:2614 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3924
Practice Address - Country:US
Practice Address - Phone:478-743-3583
Practice Address - Fax:478-743-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00254878CMedicaid