Active NPI
Tameka L Gordom
- Health Educator
- Waynesboro, GA
National Provider Identifier
1093271041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 653626
- Practice address
- 803 Shadrack St
Waynesboro, GA 30830-1244 - Phone
- (706) 535-9113
- NPI assigned
- Feb 14, 2019
- 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 |
|---|---|---|---|---|
| Health Educator | 174H00000X | 653626 | GA | Primary |
Addresses
Primary practice location
803 Shadrack St
Waynesboro, GA 30830-1244
Mailing address
803 Shadrack St
Waynesboro, GA 30830-1244
Phone (706) 535-9113
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83-3582448 | Medicaid | GA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 653626 | GA | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550102400000",
"number": "1093271041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "803 SHADRACK ST",
"city": "WAYNESBORO",
"state": "GA",
"postal_code": "308301244",
"telephone_number": "706-535-9113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "803 SHADRACK ST",
"city": "WAYNESBORO",
"state": "GA",
"postal_code": "308301244",
"telephone_number": "706-535-9113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDOM",
"first_name": "TAMEKA",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-14",
"last_updated": "2019-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Health Educator",
"state": "GA",
"license": "653626",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "83-3582448",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waynesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.