Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1134621840 |
---|---|
Provider Name | Mrs. Victoria Lenore Gordon |
First Address | Valdosta, GA 31605-4954 |
Second Address | Valdosta, GA 31602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 25/01/2022 |