Provider Demographics
NPI:1205365335
Name:GATES, JOE (PA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:GATES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 8TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4167
Mailing Address - Country:US
Mailing Address - Phone:336-838-4158
Mailing Address - Fax:
Practice Address - Street 1:408 8TH ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4167
Practice Address - Country:US
Practice Address - Phone:336-838-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty