Provider Demographics
NPI:1659960276
Name:FORTIS HEALTH, LLC
Entity Type:Organization
Organization Name:FORTIS HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-702-1806
Mailing Address - Street 1:1300 RIDENOUR BLVD NW STE 300
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4402
Mailing Address - Country:US
Mailing Address - Phone:770-702-1806
Mailing Address - Fax:770-824-4602
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1121
Practice Address - Country:US
Practice Address - Phone:770-702-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAK ANESTHESIA HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty