Provider Demographics
NPI:1548598022
Name:RANKART, GORDON J (PSYD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:J
Last Name:RANKART
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 SYLVANER LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2411
Mailing Address - Country:US
Mailing Address - Phone:205-985-9799
Mailing Address - Fax:
Practice Address - Street 1:4734 SYLVANER LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2411
Practice Address - Country:US
Practice Address - Phone:205-985-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-22
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL724103TC0700X
GAPSY002595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000075084Medicaid
ALR85538Medicare UPIN