Healthcare Provider Details

I. General information

NPI: 1245385806
Provider Name (Legal Business Name): JAMES K. FORTSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 CLEVELAND AVE SUITE 300
EAST POINT GA
30344-3618
US

IV. Provider business mailing address

PO BOX 838
TUCKER GA
30085-0838
US

V. Phone/Fax

Practice location:
  • Phone: 404-768-9350
  • Fax: 404-768-2530
Mailing address:
  • Phone: 404-768-9350
  • Fax: 404-768-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number043205
License Number StateGA

VIII. Authorized Official

Name: PIA M BERKS
Title or Position: BILLING MANAGER
Credential:
Phone: 770-378-2449