Provider Demographics
NPI:1902332364
Name:GOBER, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GOBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1866
Mailing Address - Country:US
Mailing Address - Phone:205-823-0151
Mailing Address - Fax:205-823-5218
Practice Address - Street 1:700 MONTGOMERY HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1866
Practice Address - Country:US
Practice Address - Phone:205-823-0151
Practice Address - Fax:205-823-5218
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA1230363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical