Individual
DR. MICHAEL COWL GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 WATER PL SE, SUITE 100, ATLANTA, GA 30339-2061
(770) 801-0980
(770) 801-9039
Mailing address
1800 WATER PL SE, SUITE 100, ATLANTA, GA 30339-2061
(770) 801-0980
(770) 801-9039
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
026534
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000290463A
—
GA
01
—
461670
BLUE CROSS BLUE SHIELD
GA
Enumeration date
12/04/2005
Last updated
06/18/2013
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