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NPI Code Detail

MEDICARE: DR. ANNIE MARTIN GORDON AU.D.

MEDICARE: DR. ANNIE MARTIN GORDON AU.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center2051TN
2231H00000XAudiologist2051TN

General Provider Information

NPI Number : 1073271524
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNIE MARTIN GORDON AU.D.
Provider Business Mailing Address
First Line : 104 PERRY ST
Second Line :
City : CENTERVILLE
State : TN
Zip : 37033-1310
Country : US
Telephone Number : 931-994-7586
Fax Number :
Provider Business Practice Location Address
First Line : 102 BLYTHEWOOD DR
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-4828
Country : US
Telephone Number : 931-388-3646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2021
Last Update Date : 04/10/2026

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