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NPI Code Detail

MEDICARE: MS. ALEXIS DANIELLE FORTSON

MEDICARE: MS. ALEXIS DANIELLE FORTSON
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1285002857
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALEXIS DANIELLE FORTSON
Provider Business Mailing Address
First Line : 1123 BETTY DR
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-3928
Country : US
Telephone Number : 706-326-1982
Fax Number :
Provider Business Practice Location Address
First Line : 300 COLONIAL CENTER PKWY STE NROSWELL
Second Line :
City : ROSWELL
State : GA
Zip : 30076-4899
Country : US
Telephone Number : 954-603-7885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2015
Last Update Date : 09/12/2015

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Directions to “ MS. ALEXIS DANIELLE FORTSON ” Practice Location

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