Provider Demographics
NPI:1326571720
Name:FORSTALL, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FORSTALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1222 TROTWOOD AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6422
Mailing Address - Country:US
Mailing Address - Phone:931-490-7775
Mailing Address - Fax:931-490-7797
Practice Address - Street 1:1222 TROTWOOD AVE STE 503
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6422
Practice Address - Country:US
Practice Address - Phone:931-490-7775
Practice Address - Fax:931-490-7797
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDO5216207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program