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General NPI Number Information
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NPI Number | 1922296847
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Entity Type | Organization
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Legal Business Name | FORREST J DOUD, MD, PC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 761 N CHEROKEE RD SUITE B
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City | SOCIAL CIRCLE
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State | GA
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Zip | 30025-2887
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Country | US
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Telephone | 678-374-3746
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Fax |
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Provider Business Mailing Address
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Address Line | 761 N CHEROKEE RD SUITE B
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City | SOCIAL CIRCLE
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State | GA
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Zip | 30025-2887
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Country | US
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Telephone | 678-374-3746
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FORREST J DOUD
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Credential | MD
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Telephone | 678-374-3746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 024931
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License Number State | GA
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