MS. QIANA L GORDON (NPI# 1770865420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770865420 |
| Entity Type | Individual |
| Full Name | MS. QIANA L GORDON |
| Credential | LMT |
| Practice Address |
4376 Northwind Dr Ellenwood GA 30294-2474 |
| Mailing Address |
4457 Covington Hwy Decatur GA 30035-1214 |
| Practice Telephone | 6788862203 |
| Mailing Telephone | 6788862203 |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2011-09-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | MT007007 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
4376 NORTHWIND DR |
| City | ELLENWOOD |
| State | GA |
| Zip Code | 30294-2474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124323 | Lula Varist Gholson | Counselor | Christian Counselor Ma Lou Gholson, 549 Lamar Drive, Forest Park, GA 30294 | 2019-10-04 |
| 1609428176 | Tykechia Todd | Ambulance | 3644 Caseys Cove, Ellenwood, GA 30294 | 2019-07-15 |
| 1891285243 | Ayana Aqila Thornton | Nurse Practitioner | 5654 Hosea Court, Ellenwood, GA 30294 | 2018-05-11 |
| 1346748837 | Kakethia S. Mack | Nurse Practitioner | 4124 Bosenberry Way, Ellenwood, GA 30294 | 2018-01-30 |
| 1851819312 | Tatiana Marcus | Prosthetist | 3895 Busby Mill Ct., Ellenwood, GA 30294 | 2017-09-05 |
| 1962944991 | Fairview Urgent Care, LLC | Clinic/Center | 4475 West Village Pkwy, Ellenwood, GA 30294 | 2016-11-08 |
| 1982006169 | Kristal Cure | Licensed Practical Nurse | 4057 Madiosn Court, Ellenwood, GA 30294 | 2014-09-19 |
| 1801233515 | 1st Class Learning and Performing Arts | Local Education Agency (LEA) | 5474 Platte Dr, Ellenwood, GA 30294 | 2013-06-04 |
| 1235480138 | Life Wellness Group of Atlanta | Home Delivered Meals | 145 Wilhemina Drive, Ellenwood, GA 30294 | 2012-10-02 |
| 1346548450 | William K Holley IIi | Counselor | 2732 Holly Berry Dr, Ellenwood, GA 30294 | 2011-03-14 |
| Find all providers in zip 30294 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568079911 | Derrick Andre Leach | Massage Therapist | 5685 Washakie Pt, Ellenwood, GA 30294-6697 | 2020-09-29 |
| 1427211218 | Vonda S Hendrickson | Massage Therapist | 15 Belmont Farms Dr, Ellenwood, GA 30294-2708 | 2008-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396346169 | Debra Davis | Massage Therapist | 702 Baldwin Dr Ste A, Albany, GA 31707-4027 | 2020-11-06 |
| 1780285197 | Tyrone Roy | Massage Therapist | 869 King Rd, Stone Mountain, GA 30088-2203 | 2020-11-03 |
| 1295336758 | Nadia Elizabeth Jones | Massage Therapist | 300 S Hamilton St, Dalton, GA 30720-8215 | 2020-11-02 |
| 1164022968 | Gregory R Bell Jr. | Massage Therapist | 106 W Henry St # B, Savannah, GA 31401-6721 | 2020-10-30 |
| 1770183527 | Alexander Jones | Massage Therapist | 626 Dekalb Ave Se Apt 1445, Atlanta, GA 30312-5409 | 2020-10-30 |
| 1134728124 | Quaniessa Rochelle Jenkins | Massage Therapist | 449 Oak Dr # 2, Atlanta, GA 30354-1228 | 2020-10-20 |
| 1598364630 | Amy Yang | Massage Therapist | 4505 Bradstone Trce Nw, Lilburn, GA 30047-8019 | 2020-10-20 |
| 1073112405 | Tavia Rena Bell | Massage Therapist | 2512 Grayton Loop, Villa Rica, GA 30180-6702 | 2020-10-17 |
| 1063010437 | Miranda Browne | Massage Therapist | 335 Roberts Rd, Athens, GA 30606-1227 | 2020-10-16 |
| 1710585567 | Lailyn Pineda Burkett | Massage Therapist | 3550 Ga Highway 20 South, Conyers, GA 30013-2877 | 2020-10-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.