DR. ELLIOTT GORDON (NPI# 1598260523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598260523 |
| Entity Type | Individual |
| Full Name | DR. ELLIOTT GORDON |
| Credential | MD |
| Practice Address |
744 1st St Macon GA 31201 |
| Mailing Address |
744 1st St Macon GA 31201-6840 |
| Practice Telephone | 4786337600 |
| Practice Fax Number | 4786337354 |
| Mailing Telephone | 4786337600 |
| Mailing Fax Number | 4786337354 |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2018-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 010611 | GA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
744 1ST ST |
| City | MACON |
| State | GA |
| Zip Code | 31201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972579134 | Angel Vazquez | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2006-02-27 |
| 1235796608 | Margi Patel | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2019-05-21 |
| 1558824714 | Melanie Defatima Vega | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2019-04-12 |
| 1659834323 | Mark Ricard Boudreau Jr. | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2019-04-10 |
| 1710440664 | Kristin Michelle Bird | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2019-04-08 |
| 1033672035 | Stephanie Gilman | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2019-04-08 |
| 1588141642 | Debra J Weatherall | Nurse Practitioner | 744 1st St, Macon, GA 31201-6840 | 2018-07-22 |
| 1407353246 | Ryan Bradley Davies | Pediatrics | 744 1st St, Macon, GA 31201 | 2018-04-09 |
| 1770080756 | Grace M Bernaldo | Pediatrics | 744 1st St, Macon, GA 31201 | 2018-04-06 |
| 1366948010 | Victor Manuel Ayulo | Pediatrics | 744 1st St, Macon, GA 31201 | 2018-04-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285129973 | Mary Kopp Giddens | Pediatrics | 2538 Old Holton Rd, Macon, GA 31204-1729 | 2018-06-26 |
| 1346636305 | William Wood Orr Sr. | Pediatrics | 5300 Zebulon Rd #49, Macon, GA 31210-9118 | 2015-04-07 |
| 1982038279 | Melissa Anne Steele Oh | Pediatrics | 700 Spring Street, Macon, GA 31201-3120 | 2013-08-22 |
| 1003151002 | Marcia Bender Hutchinson | Pediatrics | 149 Ashford Park, Macon, GA 31210-8016 | 2012-12-01 |
| 1144354010 | Teresa Joyce Trippe | Pediatrics | 145 Northcrest Boulevard, Macon, GA 31210 | 2007-03-15 |
| 1619034691 | Angela Richardson Barroso | Pediatrics | 4035 Elnora Drive, Macon, GA 31210 | 2007-01-02 |
| 1285792283 | Chen-kung Ho | Pediatrics | 3203 Vineville Ave, Macon, GA 31204-2323 | 2006-12-04 |
| 1578500591 | Stanley Seth Bush IIi | Pediatrics | 1508b Hardeman Ave, Macon, GA 31201-1416 | 2006-05-31 |
| 1922052554 | David N. Harvey IIi | Pediatrics | 811 Hemlock St, Macon, GA 31201-2144 | 2006-05-19 |
| 1124094065 | Elizabeth Young | Pediatrics | 1014 Forsyth St, Macon, GA 31201-2051 | 2006-02-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.