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Contact Information

MYLES S JERDAN, MEDICAL DOCTOR
1605 WHITESVILLE ST
LAGRANGE, GA30240-5903
 Phone: 877-231-3376
 Fax: 850-522-8354
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for MYLES S JERDAN · (Male)

NPI Number 1770549701
Status Active
Credentials MEDICAL DOCTOR
Entity Individual
Enumeration date 04/26/2006
Last updated 08/28/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • GA License # 030796
  • GA License # 30796
  • GA License # D30796
  • TN License # 60136
  • TN Medicaid Q053605
Hospital affiliation(s)
  • WEST GEORGIA MEDICAL CENTER - (Acute Care)
    1514 VERNON ROAD
    LAGRANGE, GA 30240
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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