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General NPI Number Information
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NPI Number | 1932191319
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Entity Type | Individual
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Provider Name | PETER LAWRENCE FORT M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 123 WEAVER RD STE B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3155
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Country | US
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Telephone | 706-835-3699
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Fax |
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Provider Business Mailing Address
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Address Line | 35 HOSPITAL RD
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3139
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Country | US
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Telephone | 706-745-2111
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Fax |
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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 | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 90203
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 90203
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License Number State | GA
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