Provider Demographics
NPI:1184608077
Name:GORDON, MICHAEL COWL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COWL
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1800 WATER PL SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2061
Mailing Address - Country:US
Mailing Address - Phone:770-801-0980
Mailing Address - Fax:770-801-9039
Practice Address - Street 1:1800 WATER PL SE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2061
Practice Address - Country:US
Practice Address - Phone:770-801-0980
Practice Address - Fax:770-801-9039
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2013-06-18
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Provider Licenses
StateLicense IDTaxonomies
GA026534207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA461670OtherBLUE CROSS BLUE SHIELD
GA000290463AMedicaid
GA000290463AMedicaid
GAB53172Medicare UPIN