Individual
CHARLES EDWARD FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
Mailing address
1103 16TH AVE SE, DECATUR, AL 35601-3595
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-049601
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51006076
BLUE CROSS BLUE SHIELD AL
AL
05
—
891017506
—
AL
Enumeration date
04/18/2007
Last updated
10/22/2007
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