Healthcare Provider Details

I. General information

NPI: 1912127994
Provider Name (Legal Business Name): JAMES R FORSTNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4654 LONG BEACH RD SE
SOUTHPORT NC
28461-8799
US

IV. Provider business mailing address

4654 LONG BEACH RD SE
SOUTHPORT NC
28461-8799
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-9564
  • Fax: 910-457-6744
Mailing address:
  • Phone: 910-457-9564
  • Fax: 910-457-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number21467
License Number StateNC

VIII. Authorized Official

Name: DR. JAMES R FORSTNER
Title or Position: OWNER
Credential: M.D.
Phone: 910-457-9564