Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | SC10344 | SC |
NPI | 1013915347 |
---|---|
Provider Name | Dr. Augustus J Goforth III |
First Address | Greenville, SC 29615-4883 |
Second Address | Greenville, SC 29615-4883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 14/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103444 | (05) | SC |
E44338 | (02) | SC |