KENNETH D GORDON (NPI# 1871549204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871549204 |
| Entity Type | Individual |
| Full Name | KENNETH D GORDON |
| Credential | MD |
| Practice Address |
1602 Vernon Rd Suite 400 Lagrange GA 30240-4100 |
| Practice Telephone | 7068829341 |
| Practice Fax Number | 7068840131 |
| Mailing Telephone | 7068829341 |
| Mailing Fax Number | 7068840131 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2011-05-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 037816 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 100064937A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225529043 | Kenneth Steven Gordon | Psychologist | 755 Lakefield Rd Ste J, Westlake Village, CA 91361-2639 | 2018-05-29 |
| 1154796456 | Kenneth Gordon | Pharmacist | 5261 Nw 81st Ter, Lauderhill, FL 33351-5050 | 2015-12-11 |
| 1497752208 | Kenneth Bryce Gordon | Optometrist | 4811 S Laburnum Ave, Richmond, VA 23231-2713 | 2005-07-07 |
| 1548301021 | Kenneth Lawrence Gordon | Psychiatry & Neurology | 75 Chestnut St., Oneonta, NY 13820 | 2007-02-09 |
| 1790865806 | Kenneth B. Gordon | Dermatology | 9200 W Wisconsin Ave, Department of Dermatology, Milwaukee, WI 53226-3522 | 2006-10-16 |
| 1104837657 | Kenneth L. Gordon | Ophthalmology | 2080 Century Park East, #800, Los Angeles, CA 90067-2011 | 2006-08-10 |
| Street Address |
1602 VERNON RD SUITE 400 |
| City | LAGRANGE |
| State | GA |
| Zip Code | 30240-4100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255333456 | Amir Usman | Internal Medicine | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-01 |
| 1346538733 | Kelly Dianne Morgan | Nurse Practitioner | 1602 Vernon Rd, Suite 400, Lagrange, GA 30240-4129 | 2011-07-19 |
| 1902001084 | Eugenia J Jones-harry | Dentist | 1602 Vernon Rd, Suite 100, Lagrange, GA 30240-4129 | 2007-06-18 |
| 1831267632 | Lagrange Internal Medicine, PC | Internal Medicine | 1602 Vernon Rd, Suite 400, Lagrange, GA 30240-4129 | 2006-12-01 |
| 1376632786 | Samuel Jones Miller IIi | Obstetrics & Gynecology | 1602 Vernon Rd, Suite 200, Lagrange, GA 30240-4129 | 2006-10-12 |
| 1790720944 | Warren J Henderson | Internal Medicine | 1602 Vernon Rd, Suite 400, Lagrange, GA 30240 | 2006-06-19 |
| 1629072699 | Richard L Ingram | Internal Medicine | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-08 |
| 1427050632 | Robert M Stout | Internal Medicine | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-01 |
| 1396747598 | Arnold Smalls | Internal Medicine | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-01 |
| 1043212236 | Anna Odom | Nurse Practitioner | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598223844 | Urgencare, LLC | Clinic/Center | 2169 West Point Road, Suite 105, Lagrange, GA 30240 | 2019-03-06 |
| 1679075527 | Georgia Pain and Spine Care, Inc | Pain Medicine | 303 Smith St Fl 2, Lagrange, GA 30240 | 2018-03-07 |
| 1629463500 | Quoc Vinh Ngo | Emergency Medicine | Wellstar West Georgia Medical Center, 1504 Vernon Road, Lagrange, GA 30240 | 2015-03-30 |
| 1770913964 | Dell H Lawson | Counselor | 300 Medical Dr. Ste 705., Lagrange, GA 30240 | 2013-11-25 |
| 1629418793 | Mortar & Pestle, LLC | Pharmacy | 205 Vernon Street, Lagrange, GA 30240 | 2013-07-03 |
| 1336582329 | Weredeselam Menna Olango | Psychiatry & Neurology | 303 Medical Dr Ste 401, Lagrange, GA 30240 | 2013-04-10 |
| 1720333743 | Mortar and Pestle, LLC | Pharmacy | 300 Mooty Bridge Road, Lagrange, GA 30240 | 2012-07-16 |
| 1366768459 | Karin Taylor | Physical Medicine & Rehabilitation | 1600 Vernon Rd Ste A, Lagrange, GA 30240 | 2010-04-14 |
| 1871819458 | Kathryn J Hill | Counselor | 100 Smith St Ste 1, Lagrange, GA 30240 | 2010-04-08 |
| 1285802751 | Air Evac Ems, Inc. | Ambulance | 455 Aerotron Pkwy, Lagrange, GA 30240 | 2008-02-18 |
| Find all providers in zip 30240 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598077398 | Leslie Jean Ogilvy | Internal Medicine | 1524 Lafayette Pkwy, Lagrange, GA 30241-2566 | 2010-07-08 |
| 1831422484 | West Georgia Medical Group-lagrange | Internal Medicine | 142 Old Mill Rd, Lagrange, GA 30241-6704 | 2009-09-15 |
| 1578727293 | Ifeoma A Ojukwu | Internal Medicine | 147 Mallard Creek Run, Lagrange, OH 44050-9803 | 2008-07-11 |
| 1326241514 | Ronald William Mcquigg | Internal Medicine | 218 East Av, Lagrange, IL 60525 | 2007-06-06 |
| 1578698429 | Frederick William Kemen | Internal Medicine | Kentucky State Reformatory, 3001 W. Highway 146, Lagrange, KY 40032-0002 | 2007-02-22 |
| 1245307735 | Gary S Griffin | Internal Medicine | 1600 Vernon Rd, Suite G, Lagrange, GA 30240-4143 | 2006-11-29 |
| 1134183742 | Ravina V Kadam | Internal Medicine | 300 Medical Dr Ste 704, Lagrange, GA 30240-4130 | 2006-04-12 |
| 1174518500 | Northeast Internal Medicine Associates,p.c | Internal Medicine | 2500 N Detroit St, Lagrange, IN 46761-1158 | 2005-09-12 |
| 1255333456 | Amir Usman | Internal Medicine | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-01 |
| 1508868704 | Anil R Modi | Internal Medicine | 300 Medical Dr, Suite 701, Lagrange, GA 30240-4130 | 2005-06-01 |
| Find all providers in LAGRANGE | ||||
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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.