Healthcare Provider Details

I. General information

NPI: 1215026372
Provider Name (Legal Business Name): JOHN ARTHUR FORTNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR SUITE 200
CHATTANOOGA TN
37404-1108
US

IV. Provider business mailing address

PO BOX 440261
NASHVILLE TN
37244-0261
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-1844
  • Fax: 423-624-2226
Mailing address:
  • Phone: 615-329-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number063585
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: