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NPI Code Detail

MEDICARE: EVAN SCOTT FORHETZ PA-C

MEDICARE: EVAN SCOTT FORHETZ PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant4506TN

General Provider Information

NPI Number : 1760076996
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN SCOTT FORHETZ PA-C
Provider Business Mailing Address
First Line : 2345 MURFREESBORO HWY
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-3206
Country : US
Telephone Number : 931-313-3818
Fax Number :
Provider Business Practice Location Address
First Line : 2345 MURFREESBORO HWY
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-3206
Country : US
Telephone Number : 931-313-3818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2021
Last Update Date : 01/20/2026

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