Provider Demographics
NPI:1841494192
Name:FORGEY, JAMES CORNELIUS III (MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CORNELIUS
Last Name:FORGEY
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 CRIPPLE CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TN
Mailing Address - Zip Code:37694-3140
Mailing Address - Country:US
Mailing Address - Phone:423-543-5224
Mailing Address - Fax:
Practice Address - Street 1:SYDNEY AND LAMONT STREETS
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1625101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor