Individual
MR. GARRY L GORDON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
0000084995
TN
183700000X
Pharmacy Technician
Primary
0000084995
TN
Other
Enumeration date
11/01/2024
Last updated
04/09/2026
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