Individual
MELISSA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADULT NP
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
1455 FOX FOREST CT SW, LILBURN, GA 30047-5520
(770) 381-0395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
RN192865
GA
207RG0100X
Gastroenterology Physician
RN192865
GA
Other
Enumeration date
09/03/2018
Last updated
09/03/2018
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