Provider Demographics
NPI:1447426200
Name:GORDON BEHAVIORAL SCIENCES P.C.
Entity Type:Organization
Organization Name:GORDON BEHAVIORAL SCIENCES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-234-0034
Mailing Address - Street 1:109 JOHN MADDOX DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1451
Mailing Address - Country:US
Mailing Address - Phone:706-234-0034
Mailing Address - Fax:706-234-0033
Practice Address - Street 1:109 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1451
Practice Address - Country:US
Practice Address - Phone:706-234-0034
Practice Address - Fax:706-234-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA185382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000227488CMedicaid
GA000227488CMedicaid
GAD30514Medicare UPIN