Individual
MARCUS FORTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 KAMINER WAY PKWY STE F, COLUMBIA, SC 29210-3986
(803) 401-5673
Mailing address
120 KAMINER WAY PKWY STE F, COLUMBIA, SC 29210-3986
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/21/2022
Last updated
10/22/2022
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