Provider Demographics
NPI:1770280877
Name:ANTHONY R. GORDON DPM, PC
Entity type:Organization
Organization Name:ANTHONY R. GORDON DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-208-9977
Mailing Address - Street 1:146 MLK JR BLVD STE 394
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5620
Mailing Address - Country:US
Mailing Address - Phone:706-208-9977
Mailing Address - Fax:949-955-7016
Practice Address - Street 1:230 CEDAR POINTE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3339
Practice Address - Country:US
Practice Address - Phone:706-208-9977
Practice Address - Fax:949-955-7016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHONY R. GORDON DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty