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
StateLicense IDTaxonomies
GA024931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty