Individual
BRENDA GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3983 LAVISTA RD, SUITE 164, TUCKER, GA 30084-5153
(404) 861-0807
Mailing address
2109 RUTHERFORD GLEN CIR, ATLANTA, GA 30340-3878
(404) 861-0807
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
059684695
GA
Other
Enumeration date
04/16/2015
Last updated
04/16/2015
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