Healthcare Provider Details

I. General information

NPI: 1548832041
Provider Name (Legal Business Name): JODIE FORBUS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MITYLENE PARK DR
MONTGOMERY AL
36117-3547
US

IV. Provider business mailing address

239 MITYLENE PARK DR
MONTGOMERY AL
36117-3547
US

V. Phone/Fax

Practice location:
  • Phone: 334-603-6626
  • Fax: 706-324-3419
Mailing address:
  • Phone: 334-603-6626
  • Fax: 706-324-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-113242
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: