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General NPI Number Information
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NPI Number | 1295542884
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Entity Type | Individual
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Provider Name | KELLEY GOFORTH DO
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 155 ACADEMY AVE
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City | GREENWOOD
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State | SC
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Zip | 29646-3869
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Country | US
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Telephone | 864-725-4865
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Fax |
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Provider Business Mailing Address
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Address Line | 121 WESTGATE DR
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City | GREENWOOD
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State | SC
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Zip | 29646-9231
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Country | US
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Telephone | 813-573-9998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 94613
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License Number State | SC
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