Individual
CHELSEA GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
340 JAKE ALEXANDER BLVD. WEST, SUITE 105, CHARLOTTE, NC 28203-5812
(704) 403-6240
Mailing address
PO BOX 602478, CHARLOTTE, NC 28260-2478
(704) 403-6240
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06438
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124477377
—
NC
05
—
2745PA
—
SC
Enumeration date
06/08/2016
Last updated
02/27/2017
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