Provider Demographics
NPI:1851808174
Name:GOULD, JONATHAN JAY MANAHAOKALANI JR
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JAY MANAHAOKALANI
Last Name:GOULD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BRASWELL RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8566
Mailing Address - Country:US
Mailing Address - Phone:808-728-2636
Mailing Address - Fax:
Practice Address - Street 1:1004 BRASWELL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8566
Practice Address - Country:US
Practice Address - Phone:808-728-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer