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NPI Code Detail

MEDICARE: GRANT BENSON FORTSON MD

MEDICARE: GRANT BENSON FORTSON MD
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
1207L00000XAnesthesiology Physician42988AL
2207L00000XAnesthesiology PhysicianE19148AR
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1437788627
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRANT BENSON FORTSON MD
Provider Business Mailing Address
First Line : PO BOX 55310
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35255-5310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 619 19TH ST S
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35233-1900
Country : US
Telephone Number : 205-934-6525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2020
Last Update Date : 02/04/2026

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