Provider Demographics
NPI:1497831101
Name:JONSKE-GUBOSH, LOU-ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LOU-ANN
Middle Name:
Last Name:JONSKE-GUBOSH
Suffix:
Gender:F
Credentials:PA-C
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 211550
Mailing Address - Street 2:ACUTE MEDICAL CONSULTING
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-1550
Mailing Address - Country:US
Mailing Address - Phone:706-250-1546
Mailing Address - Fax:706-860-7124
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:ACUTE MEDICALCONSULTING
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-250-1546
Practice Address - Fax:706-860-7124
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0002372363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ60249Medicare UPIN
GA97WCHFRMedicare ID - Type Unspecified