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General NPI Number Information
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NPI Number | 1073271524
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Entity Type | Individual
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Provider Name | ANNIE MARTIN GORDON AU.D.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 102 BLYTHEWOOD DR
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City | COLUMBIA
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State | TN
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Zip | 38401-4828
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Country | US
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Telephone | 931-388-3646
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Fax |
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Provider Business Mailing Address
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Address Line | 104 PERRY ST
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City | CENTERVILLE
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State | TN
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Zip | 37033-1310
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Country | US
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Telephone | 931-994-7586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2051
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License Number State | TN
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