NPI age
6 years
Enumerated 2019-12-16
● Active
Type 1 · Individual
Kanishia Gordon, HAIR REPL SPECIALIST
Gordon is 1 of 12 prosthetist providers in Atlanta and 1 of 90 in Georgia.
Primary specialty
Prosthetist
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2019-12-16
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 90 active prosthetist providers in Georgia.
NPI age
6 years
≈ at median (5 yr)
State licenses
1 state
1% of peers hold multiple states
Subspecialties
0
24% of peers hold subspecialties
NPI lifetime · 2019 → 2026
2019-12Enumerated in NPPES
2019
2026
Where they practice
Practice location
519 Memorial Dr Se Ste 209
Atlanta, GA 303122286
Mailing address
2025 Clearstream Overlook
Stone Mountain, GA 300884438
Specialties
-
Prosthetist PrimaryA health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs,...
Practice context
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
Recently enumerated nearby: 1 new prosthetist provider has been added in Atlanta in the last 180 days.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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