Active NPI
Chanda Monee' Gordon, DDS
- Dentist
- Atlanta, GA
National Provider Identifier
1891899050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 011655
- Practice address
- 5626 Fulton Industrial Blvd.
Suite 110
Atlanta, GA 30336 - Phone
- (404) 550-4905
- NPI assigned
- Sep 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 011655 | GA | Primary |
Addresses
Primary practice location
5626 Fulton Industrial Blvd.
Suite 110
Atlanta, GA 30336
Mailing address
7644 Cole Lane
Atlanta, GA 30349
Phone (404) 550-4905
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 |
|---|---|---|---|
| 011655 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239667200000",
"number": "1891899050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7644 COLE LANE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30349",
"telephone_number": "404-550-4905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5626 FULTON INDUSTRIAL BLVD.",
"address_2": "SUITE 110",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30336",
"telephone_number": "404-550-4905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "CHANDA",
"middle_name": "MONEE'",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-11",
"last_updated": "2009-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "011655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.