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General NPI Number Information
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NPI Number | 1851470074
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Entity Type | Individual
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Provider Name | JOHN MICHAEL GOUGH PT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6002 HIGHWAY 53 E SUITE 100
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6227
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Country | US
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Telephone | 706-265-8790
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 518
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City | JONESBORO
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State | GA
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Zip | 30237-0518
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Country | US
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Telephone | 770-631-8277
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Fax | 770-631-9403
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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 | PT008077
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License Number State | GA
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