Individual
DR. CHARLES A GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEADOWS PKWY, VIDALIA, GA 30474-8759
(912) 535-5555
(912) 535-8930
Mailing address
PO BOX 663, VIDALIA, GA 30475-0663
(912) 535-5555
(912) 535-8930
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
062039
GA
208M00000X
Hospitalist Physician
062039
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01056706
CAPITAL BLUE CROSS
PA
01
—
066957
HIGHMARK PA BLUE SHIELD
PA
01
—
110097244
PALMETTO GBA MEDICARE
PA
Enumeration date
05/10/2006
Last updated
10/17/2019
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