Provider Demographics
NPI:1013915347
Name:GOFORTH, AUGUSTUS J III (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:J
Last Name:GOFORTH
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:131 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4883
Mailing Address - Country:US
Mailing Address - Phone:864-281-9440
Mailing Address - Fax:864-281-9443
Practice Address - Street 1:131 COMMONWEALTH DR
Practice Address - Street 2:SUITE 230
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4883
Practice Address - Country:US
Practice Address - Phone:864-281-9440
Practice Address - Fax:864-281-9443
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
SCSC10344207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC103444Medicaid
SCE44338Medicare UPIN