Kanishia Gordon, HAIR REPL SPECIALIST

Primary specialty

ProsthetistTaxonomy code 224P00000X

Practice address

519 Memorial Dr SE Ste 209
Atlanta, GA 30312-2286

Phone

(404) 836-3845

NPI assigned

Dec 16, 2019

Last updated

Dec 16, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1912545393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 CLEARSTREAM OVERLOOK",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300884438",
            "telephone_number": "203-565-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 MEMORIAL DR SE STE 209",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303122286",
            "telephone_number": "404-836-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KANISHIA",
        "credential": "HAIR REPL SPECIALIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacques Lenoel Gordon, DMD
• Jameari Gordon
• James W Gordon, NP
• Jennifer Gordon, CRNA
• Julian Benjamin Gordon, M.D.
• Kara Renee Gordon, OTRL
• Karen M Gordon, NP
• Marc A Gordon Sr.
• Margaret Lanier Gordon
• Meagan Gabrielle Gordon, M.S. CCC-SLP

• Prosthetist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Prosthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.

Verify at the official NPI Registry.