Individual
MR. WILLIAM PHILLIP FORTENBERRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 PARKWAY LN, PETAL, MS 39465-3035
(601) 544-7404
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 264-6000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28846
MS
Other
Enumeration date
03/04/2015
Last updated
08/07/2023
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