Provider Demographics
NPI:1508149600
Name:GORDON, BERTHA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTHA
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:139 RALPH MCGILL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3339
Mailing Address - Country:US
Mailing Address - Phone:404-589-9040
Mailing Address - Fax:404-589-1615
Practice Address - Street 1:139 RALPH MCGILL BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3339
Practice Address - Country:US
Practice Address - Phone:404-589-9040
Practice Address - Fax:404-589-1615
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA490182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry