Healthcare Provider Details

I. General information

NPI: 1720683055
Provider Name (Legal Business Name): LAUREN GOFORTH FAULK APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARIE GOFORTH

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 16TH AVE
CORDELE GA
31015-1513
US

IV. Provider business mailing address

711 E 16TH AVE
CORDELE GA
31015-1513
US

V. Phone/Fax

Practice location:
  • Phone: 229-271-9330
  • Fax: 229-271-9245
Mailing address:
  • Phone: 229-271-9330
  • Fax: 229-271-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP280120
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: