Individual
KENNETH D GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1602 VERNON RD, SUITE 400, LAGRANGE, GA 30240-4100
(706) 882-9341
(706) 884-0131
Mailing address
1602 VERNON RD, SUITE 400, LAGRANGE, GA 30240-4100
(706) 882-9341
(706) 884-0131
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
037816
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100064937A
—
GA
Enumeration date
05/26/2006
Last updated
04/15/2024
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