Provider Demographics
NPI:1487703104
Name:DR JOHN J. FORNEY M.D., L.L.C.
Entity type:Organization
Organization Name:DR JOHN J. FORNEY M.D., L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-693-4546
Mailing Address - Street 1:181 SAINT PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6841
Mailing Address - Country:US
Mailing Address - Phone:843-693-4546
Mailing Address - Fax:843-724-8393
Practice Address - Street 1:181 SAINT PHILIP ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-6841
Practice Address - Country:US
Practice Address - Phone:843-693-4546
Practice Address - Fax:843-724-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty