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Individual

JANICE GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1120 W BUTLER RD STE I, GREENVILLE, SC 29607-4809
(864) 269-6985
(864) 751-1619
Mailing address
1120 W BUTLER RD STE I, GREENVILLE, SC 29607-4809
(864) 269-6985
(864) 751-1619

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2020-34953
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
236118
NAICS
01
238290
NAICS
01
238990
NAICS
01
333921
NAICS
01
446119
NAICS
01
532283
NAICS
01
811198
NAICS
Enumeration date
01/02/2020
Last updated
01/08/2020
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