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General NPI Number Information
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NPI Number | 1285721753
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Entity Type | Individual
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Provider Name | DENNETT HOWE GORDON PHD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 111 GREEN VIEW RD SW
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City | ROME
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State | GA
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Zip | 30165-4305
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Country | US
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Telephone | 706-235-1400
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Fax | 706-510-1357
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Provider Business Mailing Address
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Address Line | PO BOX 5072
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City | ROME
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State | GA
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Zip | 30162-5072
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Country | US
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Telephone | 706-235-1400
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Fax | 706-378-8840
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003017
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License Number State | GA
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