Gordon, Richard Alan
Gordon, Richard Alan is an sole proprietor health care provider with primary practice located at 1145 Winterberry Way Se , Conyers GA 30013-2446. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Gordon, Richard Alan can be contacted via phone (770) 483-1501.Contact Information
Primary practice address
1145 Winterberry Way Se
Conyers GA 30013-2446
Phone: (770) 483-1501
Fax: (770) 483-1894
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 020436 | Georgia |
Profile Details
| NPI number | 1942366174 |
|---|---|
| LBN Legal business name | Gordon, Richard Alan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 30th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942366174 | NPPES |
| Georgia | MEDICAID | 00198833A |
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