Provider Demographics
NPI:1104301183
Name:FORBES, CAMERON
Entity type:Individual
Prefix:
First Name:CAMERON
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 1:309 S SHARON AMITY RD # 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2978
Mailing Address - Country:US
Mailing Address - Phone:704-926-7546
Mailing Address - Fax:
Practice Address - Street 1:16623 BIRKDALE COMMONS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5622
Practice Address - Country:US
Practice Address - Phone:704-820-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86101772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered