Healthcare Provider Details

I. General information

NPI: 1144224197
Provider Name (Legal Business Name): JAMES R. GOSS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 N VALDOSTA RD
VALDOSTA GA
31602-1068
US

IV. Provider business mailing address

3527 N VALDOSTA RD
VALDOSTA GA
31602-1068
US

V. Phone/Fax

Practice location:
  • Phone: 229-247-2290
  • Fax: 229-244-2626
Mailing address:
  • Phone: 229-247-2290
  • Fax: 229-244-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number027381
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0S0006046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: