MEDICARE: AMARION FORTENBERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	291U00000X	Clinical Medical Laboratory	MS
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker	MS
4	385H00000X	Respite Care
5	376K00000X	Nurse's Aide
6	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
7	253Z00000X	In Home Supportive Care Agency
8	172A00000X	Driver

General Provider Information

NPI Number	:	1679461156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARION FORTENBERRY

Provider Business Mailing Address
First Line	:	309 LAFAYETTE ST
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-2059
Country	:	US
Telephone Number	:	601-731-8446
Fax Number	:	769-213-2422

Provider Business Practice Location Address
First Line	:	309 LAFAYETTE ST
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-2059
Country	:	US
Telephone Number	:	601-731-8446
Fax Number	:	769-213-2422

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

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/25/2025

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Directions to “ AMARION FORTENBERRY ” Practice Location

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