Individual
KANISHIA GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HAIR REPL SPECIALIST
Contact information
Practice address
519 MEMORIAL DR SE STE 209, ATLANTA, GA 30312-2286
(404) 836-3845
Mailing address
2025 CLEARSTREAM OVERLOOK, STONE MOUNTAIN, GA 30088-4438
(203) 565-5872
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
GA
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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