1215026372 NPI number — DR. JOHN ARTHUR FORTNEY M.D.

Table of content: CHLOE MEGAN JONES (NPI 1457966624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215026372 NPI number — DR. JOHN ARTHUR FORTNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORTNEY
Provider First Name:
JOHN
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215026372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440261
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37244-0261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-329-0570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 GLENWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-698-1844
Provider Business Practice Location Address Fax Number:
423-624-2226
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  063585 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162599898C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162599898D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162599898E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162599898G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162599898B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162599898A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162599898F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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