Provider Demographics
NPI:1477551380
Name:GORE, MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:GORE
Suffix:
Gender:F
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:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 E REELFOOT AVE STE F
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5867
Practice Address - Country:US
Practice Address - Phone:731-884-1412
Practice Address - Fax:731-884-1720
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD023524207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3067992Medicaid
P0018760OtherMEDICARE RAILROAD
TN103G702703OtherPTAN
TN3067992Medicaid