Individual
DR. MAXIE LERONE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
590 SPRINGRIDGE RD, CLINTON, MS 39056-5606
(601) 488-8101
(866) 499-2129
Mailing address
590 SPRINGRIDGE RD, CLINTON, MS 39056-5606
(601) 488-8101
(866) 499-2129
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9801288
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08723392
—
MS
05
—
9014277
—
MI
Enumeration date
03/23/2006
Last updated
08/20/2019
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