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General NPI Number Information
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NPI Number | 1255838546
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Entity Type | Individual
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Provider Name | LINDSEY MARIE GORDON DO
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 9 RICHLAND MEDICAL PARK DR STE 270
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City | COLUMBIA
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State | SC
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Zip | 29203-6860
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Country | US
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Telephone | 803-434-3572
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Fax | 803-434-8607
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-695-6697
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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 | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | 2556
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | 92454
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2556
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License Number State | AL
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