Fort, Larry Max

Fort, Larry Max is an individual health care provider with primary practice located at 725 S James Campbell Blvd , Columbia TN 38401-5962. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Fort, Larry Max can be contacted via phone (931) 381-3700.

Contact Information

Primary practice address
725 S James Campbell Blvd Columbia TN 38401-5962
Phone: (931) 381-3700
Fax: (931) 381-9093
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X APN0000010015 Tennessee

Profile Details

NPI number 1669402038
LBN Legal business name Fort, Larry Max
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669402038 NPPES
Tennessee MEDICAID 3626436
Tennessee Other 4067168
Tennessee Other 7235513

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