Individual
SHELLY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
155 OVERLOOK DR, COVINGTON, GA 30016-8817
(678) 702-3519
Mailing address
155 OVERLOOK DR, COVINGTON, GA 30016-8817
(678) 702-3519
Taxonomy
Speciality
Code
Description
License number
State
282J00000X
Religious Nonmedical Health Care Institution
Primary
—
—
Other
Enumeration date
06/29/2021
Last updated
06/29/2021
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