Provider Demographics
NPI:1538034467
Name:FORTSON, FREIDA J
Entity type:Individual
Prefix:MS
First Name:FREIDA
Middle Name:J
Last Name:FORTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HAMPTON PT APT 431
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9084
Mailing Address - Country:US
Mailing Address - Phone:216-356-1832
Mailing Address - Fax:
Practice Address - Street 1:400 HAMPTON PT APT 431
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9084
Practice Address - Country:US
Practice Address - Phone:216-356-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLDD1579347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle