Provider Demographics
NPI:1083635726
Name:FORREST, JOHN W JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:FORREST
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:705 JESSE JEWELL PKWY SE
Mailing Address - Street 2:STE 100
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3867
Mailing Address - Country:US
Mailing Address - Phone:770-532-9639
Mailing Address - Fax:770-532-0753
Practice Address - Street 1:705 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE 100
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3868
Practice Address - Country:US
Practice Address - Phone:770-532-9639
Practice Address - Fax:770-532-0753
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-03-18
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Provider Licenses
StateLicense IDTaxonomies
GA023956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA180001313OtherRAILROAD MCR
GA0528130001OtherCIGNA GOVERNMENT SERVICES
GAD39876Medicare UPIN