Provider Demographics
NPI:1144224197
Name:GOSS, JAMES R (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:GOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1068
Mailing Address - Country:US
Mailing Address - Phone:229-247-2290
Mailing Address - Fax:229-244-2626
Practice Address - Street 1:3527 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1068
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:229-244-2626
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027381207X00000X
FL0S0006046207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045256400OtherMEDICAID
GA00304554DMedicaid
FL045256400OtherMEDICAID
GA00304554DMedicaid
0367170001Medicare NSC