Provider Demographics
NPI:1144685637
Name:GATES, AUSTIN DALE (PA-C)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:DALE
Last Name:GATES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:111 DAVE WARLICK DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4411
Practice Address - Country:US
Practice Address - Phone:704-240-8133
Practice Address - Fax:866-493-3890
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2025-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NC0010-11404363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant