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General NPI Number Information
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NPI Number | 1982057592
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Entity Type | Individual
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Provider Name | DEBORAH FORTENBERRY L.H.I.S
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Gender | Female
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 1151 N STATE ST SUITE 107
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City | JACKSON
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State | MS
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Zip | 39202-2407
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Country | US
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Telephone | 601-352-4613
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 BUENA VISTA DRIVE
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216
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Country | US
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Telephone |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 45HAO285
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License Number State | MS
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