Individual
JEFFERSON TAYLOR GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 PROFESSIONAL PL, SUITE 202, CARROLLTON, GA 30117-3802
(770) 832-6861
(770) 832-9432
Mailing address
100 PROFESSIONAL PL, SUITE 202, CARROLLTON, GA 30117-3802
(770) 832-6861
(770) 832-9432
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
033338
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000460996C
—
GA
Enumeration date
07/17/2006
Last updated
01/04/2012
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