Provider Demographics
NPI:1720407182
Name:JONSON, KREG GOSTA (MD)
Entity Type:Individual
Prefix:DR
First Name:KREG
Middle Name:GOSTA
Last Name:JONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1511 GUNBARREL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3897
Mailing Address - Country:US
Mailing Address - Phone:423-553-5999
Mailing Address - Fax:423-602-7456
Practice Address - Street 1:1511 GUNBARREL RD STE 111
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3897
Practice Address - Country:US
Practice Address - Phone:423-553-5999
Practice Address - Fax:423-602-7456
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN57968207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics