Organization
MICHAEL C. GORDON, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL C GORDON MD (OWNER)
(770) 801-0980
Entity
Organization
Contact information
Practice address
4015 S COBB DR SE, SUITE 220, SMYRNA, GA 30080-6303
(770) 801-0980
(770) 801-9039
Mailing address
4015 S COBB DR SE, SUITE 220, SMYRNA, GA 30080-6303
(770) 801-0980
(770) 801-9039
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
026534
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
461679
BLUE CROSS BLUE SHIELD
GA
Enumeration date
08/17/2007
Last updated
08/17/2007
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