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Individual

FRED DEXTER GOSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1875 MOUNTAIN CREEK DR, STONE MOUNTAIN, GA 30087-1015
(770) 939-0778
(770) 938-6760
Mailing address
1875 MOUNTAIN CREEK DR, STONE MOUNTAIN, GA 30087-1015
(770) 939-0778
(770) 938-6760

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
28557
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0003293480
GA
01
941025
BLUE CROSS
GA
Enumeration date
06/16/2006
Last updated
05/20/2013
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