MEDICARE: MARK R. FORTSON, M.D. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	024937	GA

General Provider Information

NPI Number	:	1144390121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK R. FORTSON, M.D. P.C.

Provider Business Mailing Address
First Line	:	1907 - C 7TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901
Country	:	US
Telephone Number	:	706-653-1072
Fax Number	:	706-653-1075

Provider Business Practice Location Address
First Line	:	1907 - C 7TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901
Country	:	US
Telephone Number	:	706-653-1072
Fax Number	:	706-653-1075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK R FORTSON
Credential	:	M.D.
Telephone Number	:	706-653-1072

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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