Individual
JOHN CONRAD GOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7505 WATERS AVE, SUITE C8, SAVANNAH, GA 31406-3825
(912) 352-2606
(912) 352-0623
Mailing address
7505 WATERS AVE, SUITE C8, SAVANNAH, GA 31406-3825
(919) 352-2606
(912) 352-0629
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
028558
GA
2085N0904X
Nuclear Radiology Physician
028558
GA
2085P0229X
Pediatric Radiology Physician
028558
GA
2085R0202X
Diagnostic Radiology Physician
Primary
028558
GA
2085U0001X
Diagnostic Ultrasound Physician
028558
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330536A
—
GA
01
—
023574
BLUE CROSS
GA
01
—
30016960
KEYSTONE MERCY
GA
05
—
G28558
—
SC
Enumeration date
09/07/2005
Last updated
06/21/2012
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