Individual
MR. HUGH RUSSELL FORTENBERRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
215 MARION AVE, MCCOMB, MS 39648-2705
(601) 249-5500
(601) 249-1709
Mailing address
215 MARION AVE, MCCOMB, MS 39648-2705
(601) 249-5500
(601) 249-1709
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R860046
MS
Other
Enumeration date
06/28/2006
Last updated
07/21/2022
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