Healthcare Provider Details

I. General information

NPI: 1811945470
Provider Name (Legal Business Name): JAMES WALTER GOFORTH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 N CENTER ST
HICKORY NC
28601-1159
US

IV. Provider business mailing address

2972 N CENTER ST
HICKORY NC
28601-1159
US

V. Phone/Fax

Practice location:
  • Phone: 828-431-4955
  • Fax:
Mailing address:
  • Phone: 828-431-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number30343
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30343
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30343
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: