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General NPI Number Information
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NPI Number | 1750486858
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Entity Type | Individual
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Provider Name | WAYNE HOUSTON GORDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FERRY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 404-851-8000
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Fax | 404-303-3759
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Provider Business Mailing Address
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Address Line | 9015 BOARDWALK PL
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City | MANVEL
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State | TX
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Zip | 77578-2307
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Country | US
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Telephone | 210-725-9179
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 35122708
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 101343
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License Number State | GA
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