Provider Demographics
NPI:1467972141
Name:GOBLE, MICHELLE ANN (PA-C, ATC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANN
Last Name:GOBLE
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:GUZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, ATC
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 JULIAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9078
Practice Address - Country:US
Practice Address - Phone:704-637-3373
Practice Address - Fax:704-637-0069
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL48712255A2300X
NC0010-12182363A00000X
NCPENDING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty