Individual
JACOB KEATON GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-2429
(434) 243-5600
(434) 244-9450
Mailing address
1215 LEE ST BOX 801007, CHARLOTTESVILLE, VA 22908-0816
(434) 243-5600
(434) 244-9450
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
0116038940
VA
Other
Enumeration date
04/12/2023
Last updated
06/17/2024
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