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General NPI Number Information
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NPI Number | 1376419879
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Entity Type | Organization
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Legal Business Name | FORTRESS CLINICAL RESEARCH, INC.
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 14501 LEMOYNE BLVD
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City | BILOXI
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State | MS
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Zip | 39532-9326
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Country | US
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Telephone | 601-316-5538
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Fax |
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Provider Business Mailing Address
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Address Line | 14501 LEMOYNE BLVD
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City | BILOXI
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State | MS
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Zip | 39532-9326
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Country | US
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Telephone | 601-316-5538
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Fax |
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Authorized Official
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Title or Position | CEO/ MEDICAL DIRECTOR
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Name | MR. DEMARIO WILSON
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Credential |
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Telephone | 601-316-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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