Provider Demographics
NPI:1386236727
Name:GOFORTH, LEE ANDREW
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ANDREW
Last Name:GOFORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 14TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6408
Mailing Address - Country:US
Mailing Address - Phone:202-547-4101
Mailing Address - Fax:
Practice Address - Street 1:248 14TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6408
Practice Address - Country:US
Practice Address - Phone:202-547-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant