Jordan McKenzie Gantous, PA-C
Physician Assistant in Charlotte, NC. Individual provider (NPI-1).
NPI number1831985175
StatusActive
Last updated in NPPESApr 15, 2025
Details
- NPI
- 1831985175
- Entity type
- Individual (NPI-1)
- Name
- Jordan McKenzie Gantous
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 15, 2025
- Certification date
- Apr 15, 2025
- Last updated
- Apr 15, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0010-15178 | NC | Yes |
Practice location
3403 Steel Yard CtCharlotte, NC 28205-1262
Phone 330-241-8118
Mailing address
3403 Steel Yard CtCharlotte, NC 28205-1262
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