MEDICARE: DR. AKIL JAHI GORDON MD

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
1	208600000X	Surgery Physician	67022	GA

General Provider Information

NPI Number	:	1790076180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AKIL JAHI GORDON MD

Provider Business Mailing Address
First Line	:	805 SANDY PLAINS ROAD
Second Line	:	MEDICAL STAFF SERVICES
City	:	MARIETTA
State	:	GA
Zip	:	30066-6340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 JOHNSON FY RD NE STE 880
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1609
Country	:	US
Telephone Number	:	404-255-8304
Fax Number	:	404-256-4578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	10/19/2023

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