Provider Demographics
NPI:1639127392
Name:DOUD, FORREST J (MD)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:J
Last Name:DOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:761 N CHEROKEE RD
Mailing Address - Street 2:STE B
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-4019
Mailing Address - Country:US
Mailing Address - Phone:678-535-3030
Mailing Address - Fax:770-464-9051
Practice Address - Street 1:761 N CHEROKEE RD
Practice Address - Street 2:STE B
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-4019
Practice Address - Country:US
Practice Address - Phone:678-535-3030
Practice Address - Fax:770-464-9051
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA024931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000265944EMedicaid