Individual
SANDRA T FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-1000
Mailing address
481 FIELDS FERRY DR NE, CALHOUN, GA 30701-5900
(970) 744-1809
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
44089
CO
207L00000X
Anesthesiology Physician
67654
TN
207L00000X
Anesthesiology Physician
Primary
89073
GA
207L00000X
Anesthesiology Physician
A78957
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57650519
—
CO
Enumeration date
07/17/2006
Last updated
08/20/2024
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