Individual
NICOLE MICHELLE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 PEACHTREE ST NE STE 1600, ATLANTA, GA 30308-2246
(404) 881-1094
(404) 874-1249
Mailing address
1001 SUMMIT BLVD STE 200, BROOKHAVEN, GA 30319-6410
(770) 989-1668
(678) 388-1749
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
53536
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
647773539A
—
GA
Enumeration date
11/18/2005
Last updated
10/03/2018
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