Individual
MR. THOMAS O FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
701 S MORGAN AVE, ANDREWS, SC 29510-2959
(843) 264-5253
(843) 264-5970
Mailing address
PO BOX 1209, MURRELLS INLET, SC 29576-1209
(843) 652-8220
(843) 527-7080
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
780
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHC068
—
SC
Enumeration date
12/29/2005
Last updated
06/16/2018
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