JORDAN DOMENICK

FORT STEWART, GA
NPI1053988477
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy133V00000X Dietitian, Registered
(Licence: MO  2022036290)
Additional Taxonomies133V00000X Dietitian, Registered
(Licence: MN  4237)
Enumeration Date2021-06-04
Last Update Date2023-12-28
Business Address
JORDAN DOMENICK RD
1061 HARMON AVE
FORT STEWART, GA 31314-5641
Phone number: 912-435-6633
Mailing Address
JORDAN DOMENICK RD
1061 HARMON AVE
FORT STEWART, GA 31314-5641
Phone number: 314-691-3721