# PROFESSIONAL PARK MEDICAL SERVICES, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386662849
- **Authorized official:** JEFFERSON TAYLOR GORDON MD (FAMILY PRACTICE MD)
- **Authorized official phone:** (770) 832-6861

## Contact information

- **Practice address:** SUITE 202, 100 PROFESSIONAL PARK, CARROLLTON, GA 30117
- **Practice address phone:** (770) 832-6861
- **Practice address fax:** (770) 832-9432
- **Mailing address:** SUITE 202, 100 PROFESSIONAL PARK, CARROLLTON, GA 30117
- **Mailing address phone:** (770) 832-6861
- **Mailing address fax:** (770) 832-9432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 03/04/2016