MEDICARE: DR. MARTHA A. GORDON M.D.

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	2084P0800X	Psychiatry Physician	0000019154	TN

General Provider Information

NPI Number	:	1942254602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA A. GORDON M.D.

Provider Business Mailing Address
First Line	:	8577 CORDES CIR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-3317
Country	:	US
Telephone Number	:	901-751-4430
Fax Number	:	901-751-4210

Provider Business Practice Location Address
First Line	:	8577 CORDES CIR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-3317
Country	:	US
Telephone Number	:	901-751-4430
Fax Number	:	901-751-4210

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/06/2023

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