Individual
MAKALA RAVEN GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
775 POPLAR RD STE 160A, NEWNAN, GA 30265-8302
(770) 400-4630
Mailing address
775 POPLAR RD STE 160A, NEWNAN, GA 30265-8302
(770) 400-4630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/24/2025
Last updated
09/16/2025
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