# FOREST FAMILY PRACTICE CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235119181
- **Authorized official:** JOHN PAUL LEE M.D. (PRESIDENT)
- **Authorized official phone:** (601) 469-4861

## Contact information

- **Practice address:** 1 MEDICAL LN, FOREST, MS 39074-4039
- **Practice address phone:** (601) 469-4861
- **Practice address fax:** (601) 469-4828
- **Mailing address:** PO BOX 600, FOREST, MS 39074-0600
- **Mailing address phone:** (601) 469-4861
- **Mailing address fax:** (601) 469-4828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 05638 | MS | Yes |

## Other

- **Enumeration date:** 01/18/2006
- **Last updated:** 10/22/2008