Provider Demographics
NPI:1780612077
Name:GOMES, JOHNNY S (DO)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:S
Last Name:GOMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5046
Mailing Address - Country:US
Mailing Address - Phone:828-315-5636
Mailing Address - Fax:828-315-5656
Practice Address - Street 1:420 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5046
Practice Address - Country:US
Practice Address - Phone:828-315-5636
Practice Address - Fax:828-315-5656
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07443700207P00000X
NC146002207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2646716000OtherAMERIHEALTH
NJP00161477OtherRAILROAD MEDICARE
NJ60018859OtherHORIZON NJ HEALTH
NJ8960003Medicaid
G90866Medicare UPIN
NJ60018859OtherHORIZON NJ HEALTH
NJ064745UKEMedicare PIN
NJ2646716000OtherAMERIHEALTH
NJ8960003Medicaid
NC2401647BMedicare PIN
NC2401647AMedicare PIN