Provider Demographics
NPI:1225467848
Name:FORTITUDE MATTERS CONSULTING
Entity Type:Organization
Organization Name:FORTITUDE MATTERS CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-635-8857
Mailing Address - Street 1:4760 AUSTELL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2007
Mailing Address - Country:US
Mailing Address - Phone:770-635-8857
Mailing Address - Fax:678-903-8157
Practice Address - Street 1:4760 AUSTELL RD STE 5
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2007
Practice Address - Country:US
Practice Address - Phone:770-635-8857
Practice Address - Fax:678-903-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service