Basic Information
| Provider Information | |||||||||
| NPI: | 1811957939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOFORTH | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362772200 | ||||||||
| FaxNumber: | 3362772210 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 KIMEL PARK DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271036946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362772200 | ||||||||
| FaxNumber: | 3362772210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 200400337 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208VP0000X | 35.099053 | OH | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 200400337 | NC | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 2084H0002X | 200400337 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Hospice and Palliative Medicine | 2084P0015X | 200400337 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychosomatic Medicine | 207RH0002X | 200400337 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 2084P0805X | 200400337 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
No ID Information.