Provider Demographics
NPI:1588275978
Name:GONE, DORIS ADOFOA
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:ADOFOA
Last Name:GONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 BURNLEA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5093
Mailing Address - Country:US
Mailing Address - Phone:571-224-2917
Mailing Address - Fax:
Practice Address - Street 1:151 BURNLEA RD
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5093
Practice Address - Country:US
Practice Address - Phone:571-224-2917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant