Individual
KORREDA GAUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8120 ROURK ST, MYRTLE BEACH, SC 29572-4127
(843) 449-1438
Mailing address
1211 RAGIN ST, MYRTLE BEACH, SC 29577-3375
(843) 714-5720
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3259
SC
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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