Provider Demographics
NPI:1508284209
Name:FORGUES, MATHIEU (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHIEU
Middle Name:
Last Name:FORGUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY STE 575
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:704-100-2027
Mailing Address - Fax:770-410-0995
Practice Address - Street 1:3400 OLD MILTON PKWY STE 575
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-410-0202
Practice Address - Fax:770-410-0955
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE12339207Y00000X, 207Y00000X
GA96793207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR237696001Medicaid