| Shannon Terrell Gordon, LCSW | |
|
79 Kyndall Ln, Forsyth, GA 31029-8747 | |
| (478) 954-6802 | |
| Not Available |
| Full Name | Shannon Terrell Gordon |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 79 Kyndall Ln, Forsyth, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306948393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW001459 (Georgia) | Primary |
| Entity Name | Thriving Lane |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376122515 PECOS PAC ID: 1355741083 Enrollment ID: O20210616002689 |
| Entity Name | Grow Healthcare Group Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245845932 PECOS PAC ID: 3476961368 Enrollment ID: O20220315000829 |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Terrell Gordon, LCSW 79 Kyndall Ln, Forsyth, GA 31029-8747 Ph: (478) 954-6802 | Shannon Terrell Gordon, LCSW 79 Kyndall Ln, Forsyth, GA 31029-8747 Ph: (478) 954-6802 |
Courtney Lee Stubbs, LCSW Clinical Social Worker Medicare: May Accept Medicare Assignments Practice Location: 507 Edge Rd, Forsyth, GA 31029 Phone: 478-808-5129 | |
Amber R. Johnston, LMSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1150 River Walk, Forsyth, GA 31029 Phone: 478-954-8802 |