Basic Information
| Provider Information | |||||||||
| NPI: | 1558868851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRING | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 15TH ST # BA-2720 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309121340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067211160 | ||||||||
| FaxNumber: | 7067211158 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 CONN TER STE 550 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405083206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235867 | ||||||||
| FaxNumber: | 8593238510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 10766 | GA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | 56659 | KY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.