Oscar Gordon Jr.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT009326 Issued in GA

Practice address

2457 Dakota TRL SW
Lilburn, GA 30047-5772

Phone

(678) 531-1232

NPI assigned

Oct 9, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1497536387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4426 HUGH HOWELL RD # 117",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844918",
            "telephone_number": "678-383-7279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2457 DAKOTA TRL SW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300475772",
            "telephone_number": "678-531-1232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5370 Stone Mountain Hwy",
            "address_purpose": "LOCATION",
            "city": "Stone Mountain",
            "state": "GA",
            "postal_code": "300873581",
            "country_code": "US",
            "telephone_number": "770-498-7879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "OSCAR",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT009326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Fernando Gonzales, PT, DPT
• Thalia Krystal Gonzalez, DC
• James L Goodbread, D.C.
• Ahdae Kemba Goodwin, RBT
• Nicolette Gordon
• Nicole A Gore
• Amy Gottschang
• Tiarah Annesia Gowens, MCMHC
• Gracepoint Counseling Associates
• Faith Michelle Gray, M.D.

• Massage Therapist in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Massage Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.