Provider Demographics
NPI:1427762384
Name:FORGE HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:FORGE HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:334-790-4090
Mailing Address - Street 1:102 CLARKSDALE CT
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1270
Mailing Address - Country:US
Mailing Address - Phone:334-790-4090
Mailing Address - Fax:334-603-9532
Practice Address - Street 1:2970 ROSS CLARK CIR STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1107
Practice Address - Country:US
Practice Address - Phone:334-790-4090
Practice Address - Fax:334-603-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty