Healthcare Provider Details

I. General information

NPI: 1821094350
Provider Name (Legal Business Name): FORREST BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD CMC ANNEX 1ST FLOOR
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1000 BLYTHE BLVD. CMC ANNEX 1ST FLOOR
CHARLOTTE NC
28203
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9800199
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMC-2074
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64097
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: