Organization
FOREST FAMILY PRACTICE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PAUL LEE M.D. (PRESIDENT)
(601) 469-4861
Entity
Organization
Contact information
Practice address
1 MEDICAL LN, FOREST, MS 39074-4039
(601) 469-4861
(601) 469-4828
Mailing address
PO BOX 600, FOREST, MS 39074-0600
(601) 469-4861
(601) 469-4828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05638
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014143
—
MS
Enumeration date
01/18/2006
Last updated
10/22/2008
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