Individual
LAURA B GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20 HERRELL RD, VILLA RICA, GA 30180-5527
(770) 812-3928
(770) 812-3989
Mailing address
20 HERRELL RD, VILLA RICA, GA 30180-5527
(770) 812-3928
(770) 812-3989
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN238583
GA
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
RN238583
GA
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN238583
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN-NP238583
GA
Other
Enumeration date
09/21/2023
Last updated
10/10/2025
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