Provider Demographics
NPI:1558652016
Name:FORREST, STEPHANIE GAYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GAYLE
Last Name:FORREST
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-3950
Mailing Address - Fax:336-766-3691
Practice Address - Street 1:2821 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4137
Practice Address - Country:US
Practice Address - Phone:336-718-3950
Practice Address - Fax:336-766-3691
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC173087208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics