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Individual

JERRY K GOUGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2018 WESTERN AVE, KNOXVILLE, TN 37921-5718
(865) 544-0406
(865) 544-0480
Mailing address
30 BURTON HILLS BLVD, STE 175, NASHVILLE, TN 37215-6403
(615) 988-2014
(615) 208-1303

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1728
TN
363A00000X
Physician Assistant
Primary
1728
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1515542
TN
Enumeration date
07/21/2009
Last updated
12/29/2021
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