Provider Demographics
NPI:1922449982
Name:STATON, FORREST (PA-C)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:
Last Name:STATON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 CHATHAM FARM RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5868
Mailing Address - Country:US
Mailing Address - Phone:336-414-9390
Mailing Address - Fax:
Practice Address - Street 1:404 WESTWOOD AVE STE 107
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4316
Practice Address - Country:US
Practice Address - Phone:336-887-3195
Practice Address - Fax:336-887-3194
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant