Individual
TEQUILA S GORDON-JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
408 GENEVA AVE, MARION, SC 29571-5336
(843) 423-0120
Mailing address
3110 GREYSTONE DR, FLORENCE, SC 29501-7030
(843) 309-4150
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
123577C14
SC
Other
Enumeration date
04/06/2022
Last updated
04/06/2022
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