Individual
DR. RICHARD ALAN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1145 WINTERBERRY WAY SE, CONYERS, GA 30013-2446
(770) 483-1501
(770) 483-1894
Mailing address
1145 WINTERBERRY WAY SE, CONYERS, GA 30013-2446
(770) 483-1501
(770) 483-1894
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
020436
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00198833A
—
GA
Enumeration date
12/30/2006
Last updated
07/08/2007
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