Provider Demographics
NPI:1023007499
Name:JORDAN, MADHAVI (MD)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUIT 130
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-428-0462
Mailing Address - Fax:770-427-8001
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUIT 130
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-428-0462
Practice Address - Fax:770-427-8001
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA56725208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery