Jefferson T Gordon (NPI# 1336167816, PAC ID# 3274587399) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1336167816 |
| PAC ID by PECOS | 3274587399 |
| Professional Enrollment ID | I20081114000696 |
| Full Name | Jefferson T Gordon |
| Organization Legal Name | PROFESSIONAL PARK MEDICAL SERVICES PC |
| Address |
100 Professional Pl Suite 202 Carrollton GA 30117-3802 |
| Phone Number | 7708326861 |
| Gender | M |
| Graduation Year | 1989 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 1355335035 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110011 | TANNER MEDICAL CENTER - CARROLLTON |
| 110015 | TANNER MEDICAL CENTER VILLA RICA |
| 111320 | HIGGINS GENERAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 100 Professional Pl, Suite 202, Carrollton, GA 30117-3802 | 7708326861 | PROFESSIONAL PARK MEDICAL SERVICES PC |
| Organization Legal Name | PROFESSIONAL PARK MEDICAL SERVICES PC |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Charles H Davis Iii | Family Medicine | Professional Park Medical Services PC | 100 Professional Pl, Suite 202, Carrollton, GA 30117-3802 |
| Mechelle Patrick | Nurse Practitioner | Professional Park Medical Services PC | 100 Professional Pl, Suite 202, Carrollton, GA 30117-3802 |
| Hannah N Pollard | Nurse Practitioner | Professional Park Medical Services PC | 100 Professional Pl, Suite 202, Carrollton, GA 30117-3802 |
| Holley V Hagan | Nurse Practitioner | Professional Park Medical Services PC | 100 Professional Pl, Suite 202, Carrollton, GA 30117-3802 |
| Street Address |
100 PROFESSIONAL PL SUITE 202 |
| City | CARROLLTON |
| State | GA |
| Zip | 30117-3802 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jithender Reddy | Psychiatry | Tmc-behavioral Health of West Georgia | 100 Professional Pl, Suite 303, Carrollton, GA 30117-3872 |
| Lakshmana Daas Surapu | Psychiatry | 100 Professional Pl, Suite 301, Carrollton, GA 30117-3872 | |
| Nizamuddin Khaja | Psychiatry | Tmc-behavioral Health of West Georgia | 100 Professional Pl, Suite 303, Carrollton, GA 30117-3872 |
| Charles H Davis Iii | Family Medicine | Professional Park Medical Services PC | 100 Professional Pl, Suite 202, Carrollton, GA 30117-3802 |
| Guy H Langlo | Podiatry | 100 Professional Pl, Suite 101, Carrollton, GA 30117-3827 | |
| Mary Feldman | Dermatology | 100 Professional Pl, Suite 110, Carrollton, GA 30117-3827 | |
| Joshua E Everts | Oral Surgery | Shelby Oral Facial Surgery, P.C. | 100 Professional Pl, Suite 105, Carrollton, GA 30117-3827 |
| John Wesley Miller | Psychiatry | Tmc-behavioral Health of West Georgia | 100 Professional Pl, Suite 303, Carrollton, GA 30117-3872 |
| Yonas T Tamene | Nurse Practitioner | Tmc-behavioral Health of West Georgia | 100 Professional Pl, Suite 303, Carrollton, GA 30117-3872 |
| George F Atwell Jr. | Oral Surgery | Shelby Oral Facial Surgery, P.C. | 100 Professional Pl, Suite 105, Carrollton, GA 30117-3827 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Hermogenes B Pagsisihan | Family Medicine | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Lindsey B Roenigk | Critical Care (intensivists) | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Lauren Holcombe | Nurse Practitioner | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Savannah Bryanna Jackson | Nurse Practitioner | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Jeffrey S Reid | Internal Medicine | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Joseph M Jellicorse | Family Medicine | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Elizabeth K Scholl | Physician Assistant | Primary Care Group of West Georgia | 100 Professional Park, Suite 204, Carrollton, GA 30117 |
| Mandi C Fowler | Physician Assistant | Primary Care Group of West Georgia | 100 Professional Park, Carrollton, GA 30117 |
| James C Huff | Optometry | 702 Bankhead Hwy, Carrollton, GA 30117-1962 | |
| James Charnitski | Chiropractic | 1223 N Park St, Carrollton, GA 30117-2261 | |
| Find all physicians in zip 30117 | |||
| City | CARROLLTON |
| Zip Code | 30117 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | CARROLLTON + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Jefferson T Gordon.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.