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 |
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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 |
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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 |