Provider Demographics
NPI:1891470878
Name:GORDON, ANDRANE MONIQUE (CD)
Entity Type:Individual
Prefix:MS
First Name:ANDRANE
Middle Name:MONIQUE
Last Name:GORDON
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 NEW HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5810
Mailing Address - Country:US
Mailing Address - Phone:470-251-9733
Mailing Address - Fax:
Practice Address - Street 1:5000 SNAPFINGER WOODS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4085
Practice Address - Country:US
Practice Address - Phone:202-617-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty