Healthcare Provider Details

I. General information

NPI: 1225103302
Provider Name (Legal Business Name): BRIAN D. FORBUS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 CULTRA RD
CONWAY SC
29526-3716
US

IV. Provider business mailing address

2767 CULTRA RD
CONWAY SC
29526-3716
US

V. Phone/Fax

Practice location:
  • Phone: 843-438-8470
  • Fax:
Mailing address:
  • Phone: 843-438-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA773
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: