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NPI Code Detail

MEDICARE: MARK ROUTON FORTSON M.D.

MEDICARE:   MARK ROUTON FORTSON  M.D.
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
1207RG0100XGastroenterology Physician24937GA
2207RG0100XGastroenterology Physician024937GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
210BDHLTOTHERGAMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1457452591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ROUTON FORTSON M.D.
Provider Business Mailing Address
First Line : 2200 HAMILTON RD STE B
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-8856
Country : US
Telephone Number : 706-655-8800
Fax Number : 706-940-9767
Provider Business Practice Location Address
First Line : 2200 HAMILTON RD STE B
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-8856
Country : US
Telephone Number : 706-655-8800
Fax Number : 706-940-9767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 08/22/2022

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Directions to “ MARK ROUTON FORTSON M.D.” Practice Location

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