Individual
JESSICA GOSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 15TH ST # BI5070, AUGUSTA, GA 30912-0004
(706) 721-2423
Mailing address
722 COURTVIEW DR, AUGUSTA, GA 30909-2762
(706) 799-8626
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11158
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
359900585506
MCP
—
Enumeration date
06/15/2019
Last updated
06/15/2019
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