MEDICARE: JONATHAN GOSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35.127086	OH
2	207P00000X	Emergency Medicine Physician	079383	GA

General Provider Information

NPI Number	:	1992110555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GOSS M.D.

Provider Business Mailing Address
First Line	:	2566 SHALLOWFORD RD NE
Second Line	:	STE 104
City	:	ATLANTA
State	:	GA
Zip	:	30345-1253
Country	:	US
Telephone Number	:	713-819-6417
Fax Number	:

Provider Business Practice Location Address
First Line	:	7133 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-6606
Country	:	US
Telephone Number	:	614-293-3551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	09/27/2021

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