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Organization
FORT HEALTH MEDICAL GROUP PA
Active
Organization
FORT HEALTH MEDICAL GROUP PA
Active
Other names
Fort Health Medical Group of NC
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI CROSBY (CREDENTIALING MANAGER)
(201) 503-4815
Entity
Organization
Contact information
Practice address
212 S TRYON ST STE 100, CHARLOTTE, NC 28281-0033
(201) 208-2616
(973) 381-5773
Mailing address
613 WASHINGTON BLVD # 1297, JERSEY CITY, NJ 07310-2900
(201) 208-2616
(973) 381-5773
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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