Gordom, Tameka L
Gordom, Tameka L is an sole proprietor health care provider with primary practice located at 803 Shadrack St , Waynesboro GA 30830-1244. She recently has only one registered license in Other Service Providers / Health Educator, which is considered as her primary health care specialty. Gordom, Tameka L can be contacted via phone (706) 535-9113.Contact Information
Primary practice address
803 Shadrack St
Waynesboro GA 30830-1244
Phone: (706) 535-9113
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Health Educator | 174H00000X | 653626 | Georgia |
Profile Details
| NPI number | 1093271041 |
|---|---|
| LBN Legal business name | Gordom, Tameka L |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 14th, 2019 |
| Last updated | Feb 14th, 2019 - about 6 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 | 1093271041 | NPPES |
| Georgia | MEDICAID | 83-3582448 |
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