Provider Demographics
NPI: | 1922296847 |
---|---|
Name: | FORREST J DOUD, MD, PC |
Entity Type: | Organization |
Organization Name: | FORREST J DOUD, MD, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | FORREST |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | DOUD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 678-374-3746 |
Mailing Address - Street 1: | 761 N CHEROKEE RD |
Mailing Address - Street 2: | SUITE B |
Mailing Address - City: | SOCIAL CIRCLE |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30025-2887 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 678-374-3746 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 761 N CHEROKEE RD |
Practice Address - Street 2: | SUITE B |
Practice Address - City: | SOCIAL CIRCLE |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30025-2887 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-374-3746 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-10-04 |
Last Update Date: | 2007-10-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 024931 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |