Healthcare Provider Details

I. General information

NPI: 1265362867
Provider Name (Legal Business Name): JEFF GOFORTH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 IVYSHAW LNDG
GAINESVILLE GA
30506-8023
US

IV. Provider business mailing address

9110 IVYSHAW LNDG
GAINESVILLE GA
30506-8023
US

V. Phone/Fax

Practice location:
  • Phone: 404-780-5063
  • Fax:
Mailing address:
  • Phone: 404-780-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: