Provider Demographics
NPI:1568494037
Name:GOLLER, LINDA (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:GOLLER
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 1:806 ACQUONI RD. SUITE 100
Mailing Address - Street 2:CHEROKEE DIABETES PROGRAM
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:
Practice Address - Street 1:806 ACQUONI ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0619363A00000X
NC0010-01862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant