Organization
INTEGRAL ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEWELL WENDELL FORTENBERRY M.D. (PRESIDENT)
(770) 850-1887
Entity
Organization
Contact information
Practice address
2751 WARM SPRINGS RD, COLUMBUS, GA 31904-5244
(770) 850-1887
(770) 996-3437
Mailing address
PO BOX 490, BUFORD, GA 30515-0490
(770) 914-6777
(770) 614-6070
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA7464
RAILROAD MEDICARE GROUP #
GA
Enumeration date
04/21/2006
Last updated
08/22/2020
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