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General NPI Number Information
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NPI Number | 1538050927
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Entity Type | Individual
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Provider Name | ZACKARY GORE
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1261 N GLENWOOD AVE STE 2
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City | DALTON
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State | GA
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Zip | 30721-2603
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Country | US
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Telephone | 706-370-5840
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Fax |
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Provider Business Mailing Address
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Address Line | 98 OLD MILL RD
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City | RINGGOLD
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State | GA
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Zip | 30736-8015
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Country | US
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Telephone | 707-888-4699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 291854
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License Number State | CA
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