Provider Demographics
NPI:1124086335
Name:FORT, MARCIA E (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:E
Last Name:FORT
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 RUSH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4920
Mailing Address - Country:US
Mailing Address - Phone:910-486-5973
Mailing Address - Fax:910-486-5684
Practice Address - Street 1:610 RUSH RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4920
Practice Address - Country:US
Practice Address - Phone:910-486-5973
Practice Address - Fax:910-486-5684
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2808231H00000X
NC729237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist