Provider Demographics
NPI:1891999488
Name:SALIASHVILI, GOCHA (MD)
Entity Type:Individual
Prefix:DR
First Name:GOCHA
Middle Name:
Last Name:SALIASHVILI
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-660-5220
Mailing Address - Fax:336-660-5229
Practice Address - Street 1:3515 W MARKET ST STE 110
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4439
Practice Address - Country:US
Practice Address - Phone:336-660-5220
Practice Address - Fax:336-660-5229
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28859207RC0000X
TXBP1-0022068207RC0000X
NC795762207RC0000X
NC2020-00629207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113049Medicaid
AL515-99686OtherBCBS
ALP00770083OtherRAILROAD MEDICARE
AL510-49290OtherBCBS
AL510-49696OtherBCBS
AL515-98750OtherBCBS
Z01485OtherVIVA HEALTH
AL101885Medicaid
AL113045Medicaid
9938122OtherAETNA
AL113044Medicaid
AL113046Medicaid
AL113048Medicaid
2738776803OtherMYUTMB 2738776803-COMMERCIAL NUMBER
AL113052Medicaid
AL510-49292OtherBCBS
AL510-49291OtherBCBS
AL515-49269OtherBCBS
P00657349OtherRAILROAD MEDICARE
AL113052Medicaid
AL113049Medicaid