Provider Demographics
NPI:1861121865
Name:FORBES, CONOR
Entity type:Individual
Prefix:
First Name:CONOR
Middle Name:
Last Name:FORBES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODCOCK RD UNIT 3108
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1091
Mailing Address - Country:US
Mailing Address - Phone:912-659-4718
Mailing Address - Fax:
Practice Address - Street 1:11700 MERCY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-927-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA283720363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty