Provider Demographics
NPI:1528040748
Name:GOSE, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GOSE
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 1:176 CHARLES HARDY PKWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1836
Mailing Address - Country:US
Mailing Address - Phone:678-945-8200
Mailing Address - Fax:678-945-8209
Practice Address - Street 1:176 CHARLES HARDY PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-1836
Practice Address - Country:US
Practice Address - Phone:678-945-8200
Practice Address - Fax:678-945-8209
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine