Organization
ANITA S. GORDON
Active
Other names
Gordon Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
FELECIA BRYANT (OFC MANAGER)
(404) 486-7661
Entity
Organization
Contact information
Practice address
2814 BUFORD HWY NE, ATLANTA, GA 30329-2103
(404) 486-7661
Mailing address
2814 BUFORD HWY NE, ATLANTA, GA 30329-2103
(404) 486-7661
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
DN009248
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000225299A
—
GA
Enumeration date
07/03/2013
Last updated
07/03/2013
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