Active NPI
Indrea Janene Gordon
- Behavior Analyst
- Stockbridge, GA
National Provider Identifier
1033960059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 503 Sharpstone BND
Stockbridge, GA 30281-9434 - Phone
- (337) 309-0945
- NPI assigned
- Mar 28, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
503 Sharpstone BND
Stockbridge, GA 30281-9434
Mailing address
503 Sharpstone BND
Stockbridge, GA 30281-9434
Phone (337) 309-0945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711584000000",
"number": "1033960059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 SHARPSTONE BND",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302819434",
"telephone_number": "337-309-0945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 SHARPSTONE BND",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302819434",
"telephone_number": "337-309-0945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "INDREA",
"middle_name": "JANENE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-28",
"last_updated": "2024-03-28",
"certification_date": "2024-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.