Healthcare Provider Details

I. General information

NPI: 1750797239
Provider Name (Legal Business Name): MICAH MCGOWAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 WEDDINGTON RD
WESLEY CHAPEL NC
28104-6296
US

IV. Provider business mailing address

1043 NANCY DR
CHARLOTTE NC
28211-1532
US

V. Phone/Fax

Practice location:
  • Phone: 704-285-8411
  • Fax:
Mailing address:
  • Phone: 910-547-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: