Provider Demographics
NPI:1972537512
Name:GOUGE, SUSAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:GOUGE
Suffix:
Gender:F
Credentials:DO
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 25403
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-5403
Mailing Address - Country:US
Mailing Address - Phone:423-618-9018
Mailing Address - Fax:
Practice Address - Street 1:9309 APISON PIKE
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4340
Practice Address - Country:US
Practice Address - Phone:423-551-3562
Practice Address - Fax:423-551-3563
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine