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NPI Code Detail

MEDICARE: FRANCINE GORDON

MEDICARE: FRANCINE GORDON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerGA

General Provider Information

NPI Number : 1679980395
Entity Type Code : Individual
Provider Name (Legal Business Name) : FRANCINE GORDON
Provider Business Mailing Address
First Line : 6000 STEWART PKWY UNIT 6271
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30154-1114
Country : US
Telephone Number : 770-415-3601
Fax Number : 678-534-8986
Provider Business Practice Location Address
First Line : 12461 VETERANS MEMORIAL HWY, SUITE # 631
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30134-2025
Country : US
Telephone Number : 770-415-3601
Fax Number : 678-534-8986
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2014
Last Update Date : 08/19/2020

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