MEDICARE: MARK A FORTNEY L.AC.

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	171100000X	Acupuncturist	283	TN

General Provider Information

NPI Number	:	1336509793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A FORTNEY L.AC.

Provider Business Mailing Address
First Line	:	1613 BOSCOBEL ST # B
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-2011
Country	:	US
Telephone Number	:	828-280-0497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 BOSCOBEL ST # B
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-2011
Country	:	US
Telephone Number	:	828-280-0497
Fax Number	:

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

Provider Enumeration Date	:	02/28/2016
Last Update Date	:	02/28/2016

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Directions to “ MARK A FORTNEY L.AC.” Practice Location

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