Provider Demographics
NPI:1144097379
Name:A L GORDON CARE GROUP LLC
Entity type:Organization
Organization Name:A L GORDON CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYCKELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-730-0750
Mailing Address - Street 1:760 OLD ROSWELL RD STE 494
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2279
Mailing Address - Country:US
Mailing Address - Phone:678-730-0750
Mailing Address - Fax:678-730-0751
Practice Address - Street 1:760 OLD ROSWELL RD STE 494
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2279
Practice Address - Country:US
Practice Address - Phone:678-730-0750
Practice Address - Fax:678-730-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care