| D.keith Fortson,d.m.d.,p.c. | |
|
151 S Harkness St Jackson GA 30233-1832 | |
| (770) 775-4550 | |
| (770) 775-4338 |
| Full Name | D.keith Fortson,d.m.d.,p.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 151 S Harkness St, Jackson, Georgia |
| Authorized Official Name and Position | Dennis Keith Fortson (CEO) |
| Authorized Official Contact | 7707754550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D.keith Fortson,d.m.d.,p.c. 151 S Harkness St Jackson GA 30233-1832 Ph: (770) 775-4550 | D.keith Fortson,d.m.d.,p.c. 151 S Harkness St Jackson GA 30233-1832 Ph: (770) 775-4550 |
| NPI Number | 1033245196 |
|---|---|
| Provider Enumeration Date | 02/25/2007 |
| Last Update Date | 05/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033245196 | NPI | - | NPPES |
| 000136694A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN008764 (Georgia) | Primary |