Individual
LANDIS COFFEE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2227 US HIGHWAY 41 N, TIFTON, GA 31794-2749
(229) 386-5222
Mailing address
PO BOX 2650, TIFTON, GA 31793-2650
(229) 353-3422
(229) 391-4059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003887
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002324A
—
GA
05
—
291289900
—
FL
Enumeration date
03/14/2006
Last updated
10/10/2023
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