Gordon, Landis Coffee

Gordon, Landis Coffee is an individual health care provider with primary practice located at 2227 Us Highway 41 N , Tifton GA 31794-2749. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Gordon, Landis Coffee can be contacted via phone (229) 386-5222.

Contact Information

Primary practice address
2227 Us Highway 41 N Tifton GA 31794-2749
Phone: (229) 386-5222
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 003887 Georgia

Profile Details

NPI number 1457329641
LBN Legal business name Gordon, Landis Coffee
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Oct 10th, 2023 - about 3 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 1457329641 NPPES
Georgia MEDICAID 100002324A
Georgia MEDICAID 291289900

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