| Gordon Medical Arts Clinic | |
|
590 Springridge Rd Clinton MS 39056 | |
| (601) 488-8101 | |
| (662) 287-5678 |
| Full Name | Gordon Medical Arts Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 590 Springridge Rd, Clinton, Mississippi |
| Authorized Official Name and Position | Teandra Walton (DIRECTOR OF BUSINESS OPERATIONS) |
| Authorized Official Contact | 6014888101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gordon Medical Arts Clinic 590 Springridge Rd Clinton MS 39056-5606 Ph: (601) 488-8101 | Gordon Medical Arts Clinic 590 Springridge Rd Clinton MS 39056 Ph: (601) 488-8101 |
| NPI Number | 1114105665 |
|---|---|
| Provider Enumeration Date | 02/07/2008 |
| Last Update Date | 08/21/2019 |
| Medicare PECOS PAC ID | 1658442843 |
|---|---|
| Medicare Enrollment ID | O20080616000407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114105665 | NPI | - | NPPES |
| 08723392 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 9801288 (Mississippi) | Primary |
| Provider Name | Maxie Lerone Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427018613 PECOS PAC ID: 2466406798 Enrollment ID: I20050309000456 |
| Provider Name | Rolanda T Pace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386703171 PECOS PAC ID: 8527164326 Enrollment ID: I20070510000160 |
| Provider Name | Raymundo C Trinanes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487727095 PECOS PAC ID: 9335246727 Enrollment ID: I20070518000530 |
| Provider Name | Teresa O Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699956318 PECOS PAC ID: 6709956139 Enrollment ID: I20080528000388 |
| Provider Name | Roshundia L Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700190592 PECOS PAC ID: 6305030420 Enrollment ID: I20101103000329 |
| Provider Name | Brenda Lee Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306105705 PECOS PAC ID: 9537325980 Enrollment ID: I20120730000473 |
| Provider Name | Amanda Carson-griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124456850 PECOS PAC ID: 8022247527 Enrollment ID: I20140203001154 |
| Provider Name | Nokita T Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073763967 PECOS PAC ID: 6002137940 Enrollment ID: I20150604000871 |
| Provider Name | Laporshia Mcbeth Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710437686 PECOS PAC ID: 9335420157 Enrollment ID: I20170110000022 |
| Provider Name | Leondrea Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639608813 PECOS PAC ID: 5496025868 Enrollment ID: I20170816000194 |
| Provider Name | Bath'sheba Nicole Badon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386216166 PECOS PAC ID: 8426452129 Enrollment ID: I20210803000859 |
| Provider Name | Stacy Flowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629272596 PECOS PAC ID: 0840495214 Enrollment ID: I20220322001639 |
| Provider Name | Patricia A Dotson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245990118 PECOS PAC ID: 7911377635 Enrollment ID: I20221221000937 |
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