Individual
MS. QIANA L GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4376 NORTHWIND DR, ELLENWOOD, GA 30294-2474
(678) 886-2203
Mailing address
4457 COVINGTON HWY, DECATUR, GA 30035-1214
(678) 886-2203
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT007007
GA
Other
Enumeration date
09/19/2011
Last updated
09/19/2011
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