Healthcare Provider Details

I. General information

NPI: 1720187602
Provider Name (Legal Business Name): FOREST HEIGHTS PHCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HLTH SVCS BLDG WATSON HALL
STATESBORO GA
30460-0001
US

IV. Provider business mailing address

PO BOIX 2698
STATESBORO GA
30459-2698
US

V. Phone/Fax

Practice location:
  • Phone: 912-681-5780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHRE009060
License Number StateGA

VIII. Authorized Official

Name: JOEL SIKES
Title or Position: PRESIDENT
Credential:
Phone: 912-489-7979