Provider Demographics
NPI:1154306215
Name:FORREST, JAMES DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:FORREST
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 WOODY POINT DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7070
Mailing Address - Country:US
Mailing Address - Phone:843-359-9749
Mailing Address - Fax:
Practice Address - Street 1:747 WOODY POINT DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7070
Practice Address - Country:US
Practice Address - Phone:843-359-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00503367500000X
AL1-103958367500000X
SC1775367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051527738Medicaid
AL515-27738OtherBCBS
ALP00240122OtherRR MEDICARE
AL515-27738OtherBCBS