Healthcare Provider Details

I. General information

NPI: 1639127392
Provider Name (Legal Business Name): FORREST J DOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 N CHEROKEE RD STE B
SOCIAL CIRCLE GA
30025-4019
US

IV. Provider business mailing address

761 N CHEROKEE RD STE B
SOCIAL CIRCLE GA
30025-4019
US

V. Phone/Fax

Practice location:
  • Phone: 678-535-3030
  • Fax: 770-464-9051
Mailing address:
  • Phone: 678-535-3030
  • Fax: 770-464-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number024931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: