Individual
MARY GORDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
501 MARSHALL ST, SUITE 100, JACKSON, MS 39202-1651
(601) 948-1416
(601) 353-9417
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R678163
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07625023
—
MS
Enumeration date
02/05/2007
Last updated
03/09/2018
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