Individual
STEPHANIE H GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2750 OWENS RD SW, SUITE A, CONYERS, GA 30094-3991
(678) 413-4644
(678) 413-4624
Mailing address
2750 OWENS RD SW, SUITE A, CONYERS, GA 30094-3991
(678) 413-4644
(678) 413-4624
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
049382
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
551117710A
—
GA
Enumeration date
08/23/2005
Last updated
08/06/2012
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