Provider Demographics
NPI:1558559096
Name:MARTHA A GORDON, MD, PC
Entity Type:Organization
Organization Name:MARTHA A GORDON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-751-4430
Mailing Address - Street 1:150 TIMBER CREEK DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4236
Mailing Address - Country:US
Mailing Address - Phone:901-751-4430
Mailing Address - Fax:901-751-4210
Practice Address - Street 1:150 TIMBER CREEK DR STE 6
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4236
Practice Address - Country:US
Practice Address - Phone:901-751-4430
Practice Address - Fax:901-751-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNE572312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377055Medicare PIN