| Forest Family Practice | |
|
1 Medical Ln Ste B Forest MS 39074-4039 | |
| (601) 469-4861 | |
| Not Available |
| Full Name | Forest Family Practice |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1 Medical Ln Ste B, Forest, Mississippi |
| Authorized Official Name and Position | John P Lee (COB) |
| Authorized Official Contact | 6014694861 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forest Family Practice 100 Pioneer Way Magee MS 39111-5501 Ph: (601) 849-6440 | Forest Family Practice 1 Medical Ln Ste B Forest MS 39074-4039 Ph: (601) 469-4861 |
| NPI Number | 1649761685 |
|---|---|
| Provider Enumeration Date | 05/25/2018 |
| Last Update Date | 05/26/2020 |
| Certification Date | 05/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649761685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
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