Gordon, Jefferson Taylor

Gordon, Jefferson Taylor is an individual health care provider with primary practice located at 100 Professional Pl Suite 202, Carrollton GA 30117-3802. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gordon, Jefferson Taylor can be contacted via phone (770) 832-6861.

Contact Information

Primary practice address
100 Professional Pl Suite 202 Carrollton GA 30117-3802
Phone: (770) 832-6861
Fax: (770) 832-9432
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 033338 Georgia

Profile Details

NPI number 1336167816
LBN Legal business name Gordon, Jefferson Taylor
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Jan 4th, 2012 - about 14 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 1336167816 NPPES
Georgia MEDICAID 000460996C

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