JORDAN LICATA DO
Individual Provider (NPI-1)
Active
Otolaryngology
Provider Information
- NPI Number
1952795106- Provider Type
- Individual Provider (NPI-1)
- Credentials
- DO
- Status
- Active
Contact & Location
- Address
- 1821 N WASHINGTON ST, TULLAHOMA, TN, 373882221
- Phone
- (931) 461-5056
- Fax
- (931) 455-4450
Specialties & Taxonomies
Otolaryngology
License: KY #05799
Otolaryngology
Primary License: TN #5294