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1275083651 NPI number — MICHAEL L GOFORTH AUD

NPI Number: 1275083651
Health Care Provider/Practitioner: MICHAEL L GOFORTH AUD

Information about “1275083651” NPI (MICHAEL L GOFORTH AUD) exists in 1275083651 in HTML format HTML  |  1275083651 in plain Text format TXT  |  1275083651 in PDF (Portable Document Format) PDF  |  1275083651 in an XML format XML  formats.

NPI Number : 1275083651 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275083651",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOFORTH",
    "FirstName": "MICHAEL",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "AUD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7215 COMMONS CIR UNIT C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHEYENNE",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82009-2666",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-637-7415",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3400 OLD MILTON PKWY",
    "SecondLinePracticeLocationAddress": "BLDG C, STE 575",
    "PracticeLocationAddressCityName": "ALPHARETTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30005-3707",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-410-0202",
    "PracticeLocationAddressFaxNumber": "770-410-0955",
    "EnumerationDate": "10/10/2016",
    "LastUpdateDate": "05/18/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "237600000X",
          "TaxonomyName": "Audiologist-Hearing Aid Fitter",
          "LicenseNumber": "A-1012",
          "LicenseNumberStateCode": "WY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "AUD004125",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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