Kali L Gordon, M.D., M.S.
Individual provider Active NPI Family Medicine Physician · Alturas, CA
NPI 1508106600 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1508106600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 72733 (GA)
- Practice address
- Pit River Health Service
150 Bureau of Indian Affairs #76a
Alturas, CA 96101 - Phone
- (530) 233-3223
- Fax
- (530) 233-3296
- NPI assigned
- Feb 26, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180803000622 | GA | Practitioner - General Practice | 7012265275 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72733 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstreet of Georgia PC | Single Specialty | Current |
Accepting new patients |
| Southern Regional Physicians Management Group, LLC | Single Specialty | Current |
Accepting new patients |
| United Physician Group LLC | Single Specialty | Current |
Accepting new patients |
| St. Joseph Clinic, P.C. | Single Specialty | Past |
Accepting new patients |
Locations
2292 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 382-9941
3999 Austell Rd
Ste 901
Austell, GA 30106
Phone (770) 809-3032
13 Corporate Blvd NE
Ste 100
Brookhaven, GA 30329
Phone (229) 442-7210
3970 Five Forks Trickum Rd SW
#A
Lilburn, GA 30047
Phone (678) 880-4836
8052 Mall Pkwy
Ste 103
Lithonia, GA 30038
Phone (404) 289-4556
11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277
33 Upper Riverdale Rd SW
Ste 112
Riverdale, GA 30274
Phone (770) 996-3190
921 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (770) 506-3386
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 72733 | GA | Yes |
Addresses
Primary practice location
Pit River Health Service
150 Bureau of Indian Affairs #76a
Alturas, CA 96101
Mailing address
412 E North St Unit a
Alturas, CA 96101-4072
Phone (215) 260-8867
Other providers in Alturas, CA
- Kathryn Marie Floyd
- Tiffany June Ford
- Jack R Futterman
- Melissa Sue Gallardo
- Barbara E Gilbertson
- Ronald Gray
- Julia Greene
- Nathan Michael Gremillion
- Landin Paul Hagge
- Philip Harvey
All providers in Alturas, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.