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General NPI Number Information
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NPI Number | 1174468615
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Entity Type | Individual
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Provider Name | MR. GORDON SAMUEL ANDREWS JR.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 1900 DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1979
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Country | US
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Telephone | 352-394-4071
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Fax |
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Provider Business Mailing Address
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Address Line | 17511 DELLA ROPER RD
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City | MOSS POINT
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State | MS
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Zip | 39562-8532
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Country | US
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Telephone | 228-219-3229
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 922516
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License Number State | MS
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