Forrest Clark Cantrell Jr., M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

028948 Issued in GA

Practice address

3515 Dallas Hwy
Ste C
Marietta, GA 30064

Phone

(770) 943-9150

Fax

(770) 212-0276

NPI assigned

May 27, 2006

Last updated

May 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fcantrell31774@directwellstar.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Dahlonega Pediatric and Adolescent Medicine

  dba Dahlonega Pediatrics

  • Rural Health Clinic/Center
  • Dahlonega, GA
  • NPI 1427333095
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1881641793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 DALLAS HWY",
            "address_2": "STE 200",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276318",
            "telephone_number": "770-943-9150",
            "fax_number": "770-212-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 DALLAS HWY",
            "address_2": "STE C",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30064",
            "telephone_number": "770-943-9150",
            "fax_number": "770-212-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTRELL",
        "first_name": "FORREST",
        "middle_name": "CLARK",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "028948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00382489A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000382489G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deja Shanay Cannon
• Canopy Counseling & Consulting
• Canopy Homecare, LLC (BWell Senior Care)
• Alexander Cantral, MD
• David M Cantrell, MD
• Rachael Elizabeth Cantrell, MS OTR/L
• Ryan V Cantwell, MD
• Lydia J Canty, LPC, NCC
• Melissa E Caplan, PA-C
• William Zachary Capland, PA

• Pediatrics Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.