Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 9701355 | NC |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 9701355 | NC |
NPI | 1154439149 |
---|---|
Provider Name | James Forrester JR. |
First Address | Atlanta, GA 31193-6857 |
Second Address | Wilmington, NC 28401-7338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C79967 | (02) | NC |