Provider Demographics
NPI:1710669494
Name:FORT, ANDIE
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:
Last Name:FORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2310
Mailing Address - Country:US
Mailing Address - Phone:251-423-5522
Mailing Address - Fax:
Practice Address - Street 1:4000 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1780
Practice Address - Country:US
Practice Address - Phone:251-380-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program