Provider Demographics
NPI:1467623421
Name:GOSU, GOUTHAM K (AUD, CCC-A, F-AAA)
Entity type:Individual
Prefix:DR
First Name:GOUTHAM
Middle Name:K
Last Name:GOSU
Suffix:
Gender:M
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 COLONY RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5022
Mailing Address - Country:US
Mailing Address - Phone:704-944-4283
Mailing Address - Fax:980-819-7817
Practice Address - Street 1:3900 COLONY RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5022
Practice Address - Country:US
Practice Address - Phone:704-944-4283
Practice Address - Fax:980-819-7817
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11105231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter