Healthcare Provider Details

I. General information

NPI: 1184620270
Provider Name (Legal Business Name): MARILYN SCHULZ GORDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

856 W 4TH NORTH ST
MORRISTOWN TN
37814-3813
US

IV. Provider business mailing address

856 W 4TH NORTH ST
MORRISTOWN TN
37814-3813
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-0067
  • Fax: 423-581-5882
Mailing address:
  • Phone: 423-587-0067
  • Fax: 423-581-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number019858
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: