Provider Demographics
NPI:1043206782
Name:GORE, SHAWNYA AYERS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWNYA
Middle Name:AYERS
Last Name:GORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1867 REMOUNT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7401
Mailing Address - Country:US
Mailing Address - Phone:704-854-8799
Mailing Address - Fax:704-854-8803
Practice Address - Street 1:1867 REMOUNT RD
Practice Address - Street 2:SUITE D
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7401
Practice Address - Country:US
Practice Address - Phone:704-854-8799
Practice Address - Fax:704-854-8803
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9900851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891225JMedicaid
SCN00852Medicaid
NC2278146Medicare PIN
SCN00852Medicaid