Organization
MADE WHOLE HEALTHCARE SOLUTIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEDRA S FORTSON APRN (NURSE PRACTITIONER)
(770) 330-8496
Entity
Organization
Contact information
Practice address
2709 GILLIONVILLE RD, ALBANY, GA 31721-6271
(229) 483-0020
(229) 483-0021
Mailing address
PO BOX 71802, ALBANY, GA 31708-1802
(770) 330-8496
(229) 888-7421
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
RN131505
GA
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20250I9514
MEDICARE PTAN
GA
05
—
217951
—
GA
Enumeration date
01/30/2015
Last updated
07/10/2019
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