Gordon, Kenneth D
Gordon, Kenneth D is an individual health care provider with primary practice located at 1602 Vernon Rd Suite 400, Lagrange GA 30240-4100. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gordon, Kenneth D can be contacted via phone (706) 882-9341.Contact Information
Primary practice address
1602 Vernon Rd Suite 400
Lagrange GA 30240-4100
Phone: (706) 882-9341
Fax: (706) 884-0131
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 037816 | Georgia |
Profile Details
| NPI number | 1871549204 |
|---|---|
| LBN Legal business name | Gordon, Kenneth D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 26th, 2006 |
| Last updated | Apr 15th, 2024 - about last year |
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 | 1871549204 | NPPES |
| Georgia | MEDICAID | 100064937A |
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