Active NPI
Richard Alan Gordon, M.D.
- Specialist
- Conyers, GA
National Provider Identifier
1942366174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 020436
- Practice address
- 1145 Winterberry Way SE
Conyers, GA 30013-2446 - Phone
- (770) 483-1501
- Fax
- (770) 483-1894
- NPI assigned
- Dec 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 020436 | GA | Primary |
Addresses
Primary practice location
1145 Winterberry Way SE
Conyers, GA 30013-2446
Mailing address
1145 Winterberry Way SE
Conyers, GA 30013-2446
Phone (770) 483-1501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00198833A | Medicaid | GA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020436 | GA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlantic Radiology Associates, LLC | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Houston Hospitals Inc | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Diagnostic Radiology Physician
- Savannah, GA
- NPI 1033136080
-
dba Jefferson Hospital
- Psychiatric Hospital Unit
- Louisville, GA
- NPI 1417554437
-
dba Jefferson Hospital
- General Acute Care Hospital
- Louisville, GA
- NPI 1710992433
-
dba Emory Hospital Warner Robins
- General Acute Care Hospital
- Warner Robins, GA
- NPI 1962435792
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942366174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 WINTERBERRY WAY SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300132446",
"telephone_number": "770-483-1501",
"fax_number": "770-483-1894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 WINTERBERRY WAY SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300132446",
"telephone_number": "770-483-1501",
"fax_number": "770-483-1894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "RICHARD",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "020436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00198833A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.