Provider Demographics
NPI:1578507661
Name:WARD, FORREST C (MD)
Entity Type:Individual
Prefix:MR
First Name:FORREST
Middle Name:C
Last Name:WARD
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 1:6644 SUMMER KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2875
Mailing Address - Country:US
Mailing Address - Phone:901-266-4112
Mailing Address - Fax:901-266-4113
Practice Address - Street 1:6644 SUMMER KNOLL CIR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2875
Practice Address - Country:US
Practice Address - Phone:901-266-4112
Practice Address - Fax:901-266-4113
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3016448Medicaid
TN4156031OtherBLUE CROSS BLUE SHIELD OF TN
TN3016448Medicaid
TN30164401Medicare PIN