Individual
FORREST A POMMERENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1714 HIGHWAY 17 S, NORTH MYRTLE BEACH, SC 29582-4041
(843) 361-0705
(843) 361-4045
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22630
SC
208D00000X
General Practice Physician
22630
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226302
—
SC
Enumeration date
07/05/2006
Last updated
10/31/2024
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