| Doctor Name: | MR. THOMAS O FORT |
| NPI Number: | 1144207382 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 780 |
| Business Practice Address: | 701 S Morgan Ave Andrews, SC - 295102959 |
| Business Phone Number: | 8432645253 |
| Business Fax Number: | 8432645970 |
| Mailing Address: | Po Box 1209, MURRELLS INLET |
| State: | SC |
| Postal Code: | 295761209 |
| Phone Number: | 8436528220 |
| Fax Number: | 8435277080 |
| NPI Enumeration Date: | 12/29/2005 |
| NPI Last Update Date: | 09/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |