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NPI Code Detail

MEDICARE: JAMES FORTENBERRY MD

MEDICARE: JAMES FORTENBERRY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0203XPediatric Critical Care Medicine Physician35875GA

General Provider Information

NPI Number : 1194788869
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES FORTENBERRY MD
Provider Business Mailing Address
First Line : 1575 NORTHEAST EXPY NE
Second Line :
City : BROOKHAVEN
State : GA
Zip : 30329-2401
Country : US
Telephone Number : 404-785-1313
Fax Number : 404-785-6233
Provider Business Practice Location Address
First Line : 1575 NORTHEAST EXPY NE
Second Line :
City : BROOKHAVEN
State : GA
Zip : 30329-2401
Country : US
Telephone Number : 404-785-1313
Fax Number : 404-785-6233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 06/06/2022

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