Active NPI
Jerry Wayne Gordon III, RN
- Registered Nurse
- Birmingham, AL
National Provider Identifier
1477988632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 1-141671
- Practice address
- 2868 Acton Road
Birmingham, AL 35243-2502 - Phone
- (205) 968-8360
- Fax
- (205) 968-8361
- NPI assigned
- Sep 6, 2013
- Last updated
- Sep 6, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 1-141671 | AL | Primary |
Addresses
Primary practice location
2868 Acton Road
Birmingham, AL 35243-2502
Mailing address
2868 Acton Road
Birmingham, AL 35243-2502
Phone (205) 968-8360
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-141671 | AL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378425600000",
"number": "1477988632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2868 ACTON ROAD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352432502",
"telephone_number": "205-968-8360",
"fax_number": "205-968-8361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2868 ACTON ROAD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352432502",
"telephone_number": "205-968-8360",
"fax_number": "205-968-8361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "JERRY",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-06",
"last_updated": "2013-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "AL",
"license": "1-141671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.