MEDICARE: DR. JAMES R. GOSSAGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	038782	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295845634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R. GOSSAGE MD

Provider Business Mailing Address
First Line	:	1499 WALTON WAY STE 1400
Second Line	:	ATTN: L. HATHAWAY
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2603
Country	:	US
Telephone Number	:	706-721-4501
Fax Number	:	706-721-1459

Provider Business Practice Location Address
First Line	:	1499 WALTON WAY STE 1400
Second Line	:	ATTN: L. HATHAWAY
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2603
Country	:	US
Telephone Number	:	706-721-4501
Fax Number	:	706-721-1459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/26/2014

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