Provider Demographics
NPI:1588990089
Name:FORTNER, JAMES L (DDS,PC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:FORTNER
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3402
Mailing Address - Country:US
Mailing Address - Phone:615-797-5877
Mailing Address - Fax:615-797-5880
Practice Address - Street 1:4335 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9234
Practice Address - Country:US
Practice Address - Phone:615-797-5878
Practice Address - Fax:615-797-5880
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice