Provider Demographics
NPI:1457184145
Name:GORDON, CHRISTOPHER JAMES JR
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:GORDON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SUMMER PL NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-6071
Mailing Address - Country:US
Mailing Address - Phone:470-985-0779
Mailing Address - Fax:
Practice Address - Street 1:53 SUMMER PL NW
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-6071
Practice Address - Country:US
Practice Address - Phone:470-985-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician