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General NPI Number Information
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NPI Number | 1972537512
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Entity Type | Individual
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Provider Name | SUSAN J GOUGE DO
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 9309 APISON PIKE
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City | OOLTEWAH
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State | TN
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Zip | 37363-4340
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Country | US
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Telephone | 423-551-3562
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Fax | 423-551-3563
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Provider Business Mailing Address
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Address Line | PO BOX 25403
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City | CHATTANOOGA
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State | TN
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Zip | 37422-5403
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Country | US
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Telephone | 423-618-9018
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO0000001721
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License Number State | TN
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