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1750486858 NPI number — WAYNE HOUSTON GORDON M.D.

NPI Number: 1750486858
Health Care Provider/Practitioner: WAYNE HOUSTON GORDON M.D.

Information about “1750486858” NPI (WAYNE HOUSTON GORDON M.D.) exists in 1750486858 in HTML format HTML  |  1750486858 in plain Text format TXT  |  1750486858 in PDF (Portable Document Format) PDF  |  1750486858 in an XML format XML  formats.

NPI Number : 1750486858 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750486858",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GORDON",
    "FirstName": "WAYNE",
    "MiddleName": "HOUSTON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9015 BOARDWALK PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANVEL",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77578-2307",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-725-9179",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1000 JOHNSON FERRY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30342-1606",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-851-8000",
    "PracticeLocationAddressFaxNumber": "404-303-3759",
    "EnumerationDate": "09/13/2006",
    "LastUpdateDate": "08/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "35122708",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "101343",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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