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NPI Code Detail

MEDICARE: SARAH ROXANNE FORT

MEDICARE: SARAH ROXANNE FORT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1801677315
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH ROXANNE FORT
Provider Business Mailing Address
First Line : 305 S OAK ST
Second Line :
City : SPRINGFIELD
State : GA
Zip : 31329-6701
Country : US
Telephone Number : 912-660-9919
Fax Number :
Provider Business Practice Location Address
First Line : 100 COMMERCE CT
Second Line :
City : POOLER
State : GA
Zip : 31322-9445
Country : US
Telephone Number : 615-560-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2023
Last Update Date : 10/10/2023

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Directions to “ SARAH ROXANNE FORT ” Practice Location

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