MEDICARE: DR. JAMES FORTSON MD MBA MPH FACS

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	207Y00000X	Otolaryngology Physician	043205	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205836194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES FORTSON MD MBA MPH FACS

Provider Business Mailing Address
First Line	:	PO BOX 838
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30085-0838
Country	:	US
Telephone Number	:	404-768-9351
Fax Number	:	404-768-2530

Provider Business Practice Location Address
First Line	:	1136 CLEVELAND AVE
Second Line	:	SUITE 300
City	:	EAST POINT
State	:	GA
Zip	:	30344-3618
Country	:	US
Telephone Number	:	404-768-9350
Fax Number	:	404-768-2530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/18/2013

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