Provider Demographics
NPI:1457222770
Name:JORDAN, TIESHIA SHADIA
Entity type:Individual
Prefix:MS
First Name:TIESHIA
Middle Name:SHADIA
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 1:1030 CENTRAL DR NW STE A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2249
Mailing Address - Country:US
Mailing Address - Phone:980-331-2463
Mailing Address - Fax:
Practice Address - Street 1:1030 CENTRAL DR NW STE A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2249
Practice Address - Country:US
Practice Address - Phone:980-331-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist