Healthcare Provider Details

I. General information

NPI: 1114858339
Provider Name (Legal Business Name): FORT HEALTH PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DODSON AVE STE 280
FORT SMITH AR
72901-5182
US

IV. Provider business mailing address

1500 DODSON AVE STE 280
FORT SMITH AR
72901-5182
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-7480
  • Fax:
Mailing address:
  • Phone: 479-709-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MOUSSALLEM
Title or Position: SOLE OWNER
Credential: MD
Phone: 856-506-5794