Provider Demographics
NPI:1366767444
Name:FORREST, GEORGIA (MD)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:BROMFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4250 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2559
Mailing Address - Country:US
Mailing Address - Phone:678-567-8000
Mailing Address - Fax:770-439-3555
Practice Address - Street 1:4250 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2559
Practice Address - Country:US
Practice Address - Phone:678-567-8000
Practice Address - Fax:770-439-3555
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271138-1207Q00000X
390200000X
GA72267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program