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Individual

MR. JORY CHRISTOPHER JAMES GOTHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4607 MACCORKLE AVE SW STE 401, SOUTH CHARLESTON, WV 25309-1364
(304) 414-2120
Mailing address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 414-4800

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
819
WV
363AS0400X
Surgical Physician Assistant
Primary
819
WV

Other

Enumeration date
09/22/2015
Last updated
12/23/2021
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