Organization
PROFESSIONAL PARK MEDICAL SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERSON TAYLOR GORDON MD (FAMILY PRACTICE MD)
(770) 832-6861
Entity
Organization
Contact information
Practice address
SUITE 202, 100 PROFESSIONAL PARK, CARROLLTON, GA 30117
(770) 832-6861
(770) 832-9432
Mailing address
SUITE 202, 100 PROFESSIONAL PARK, CARROLLTON, GA 30117
(770) 832-6861
(770) 832-9432
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ2154
MEDICARE RAILROAD
GA
Enumeration date
07/17/2006
Last updated
03/04/2016
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