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Edward Gordon Jr.

Technician, Attendant Care Provider in Tallahassee, FL. Individual provider (NPI-1).

NPI number1386278596
StatusActive
Last updated in NPPESFeb 26, 2020

Details

NPI
1386278596
Entity type
Individual (NPI-1)
Name
Mr. Edward Gordon Jr.
Sex
Male
Sole proprietor
Yes
Enumeration date
Feb 26, 2020
Certification date
Feb 26, 2020
Last updated
Feb 26, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3747A0650X Technician, Attendant Care Provider––Yes

Practice location

2472 Chateau Ln
Tallahassee, FL 32311-5604

Phone 850-896-4709

Mailing address

115 S Pinetree Blvd Apt 1205
Bldg 12
Thomasville, GA 31792-7175

Phone 229-221-5073

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