Provider Demographics
NPI:1295845634
Name:GOSSAGE, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:GOSSAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WALTON WAY STE 1400
Mailing Address - Street 2:ATTN: L. HATHAWAY
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2603
Mailing Address - Country:US
Mailing Address - Phone:706-721-4501
Mailing Address - Fax:706-721-1459
Practice Address - Street 1:1499 WALTON WAY STE 1400
Practice Address - Street 2:ATTN: L. HATHAWAY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2603
Practice Address - Country:US
Practice Address - Phone:706-721-4501
Practice Address - Fax:706-721-1459
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038782207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG38782Medicaid
GA000619066AMedicaid
GA000619066AMedicaid
E90256Medicare UPIN