Individual
GWENDA FAYE GOGGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
830 S GLOSTER ST, TUPELO, MS 38801-4934
(662) 377-6608
Mailing address
3912 WATER OAK CT, SALTILLO, MS 38866-6899
(662) 844-9095
(662) 844-9095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110840426
VA
363AM0700X
Medical Physician Assistant
0110840426
VA
363AM0700X
Medical Physician Assistant
PA078
MS
Other
Enumeration date
05/25/2006
Last updated
03/07/2023
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