Jerdan, Myles Sidney

Jerdan, Myles Sidney is an individual health care provider with primary practice located at 1605 Whitesville St , Lagrange GA 30240-5903. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Jerdan, Myles Sidney can be contacted via phone (877) 231-3376.

Contact Information

Primary practice address
1605 Whitesville St Lagrange GA 30240-5903
Phone: (877) 231-3376
Fax: (850) 522-8354
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 60136 Tennessee
Allopathic & Osteopathic Physicians / Dermatology 207N00000X D30796 Georgia
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 030796 Georgia
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 30796 Georgia

Profile Details

NPI number 1770549701
LBN Legal business name Jerdan, Myles Sidney
Credentials MEDICAL DOCTOR
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2006
Last updated Aug 28th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770549701 NPPES
Tennessee MEDICAID Q053605

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