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General NPI Number Information
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NPI Number | 1841254166
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Entity Type | Individual
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Provider Name | DR. SAMUEL L. FORT
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 203B MOCKSVILLE AVE
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City | SALISBURY
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State | NC
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Zip | 28144-3325
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Country | US
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Telephone | 704-636-0971
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Fax | 704-636-8854
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Provider Business Mailing Address
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Address Line | PO BOX 2145 203 B MOCKSVILLE AVENUE
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City | SALISBURY
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State | NC
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Zip | 28145-2145
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Country | US
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Telephone | 704-636-0971
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Fax | 704-636-8554
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 9501242
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License Number State | NC
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