Individual
DR. JOHNATHAN RICHARD GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3651 WHEELER RD, AUGUSTA, GA 30909-6521
(706) 560-2273
(706) 560-0903
Mailing address
PO BOX 211550, AUGUSTA, GA 30917-1550
(706) 855-9860
(706) 860-7124
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36164
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000780645D
—
GA
01
—
36164
MEDICAL LICENSE
GA
Enumeration date
07/18/2006
Last updated
08/28/2014
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