William Phillip Fortenberry Jr.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

28846 Issued in MS

Practice address

50 Parkway LN
Petal, MS 39465-3035

Phone

(601) 544-7404

NPI assigned

Mar 4, 2015

Last updated

Aug 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Mississippi School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mississippi Homecare of Richton Home health agency, Richton, MS, CCN 257120
• Enhabit Home Health & Hospice Home health agency, Hattiesburg, MS, CCN 257091
• Forrest General Home Care Home health agency, Hattiesburg, MS, CCN 257127
• Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wfortenberry100084@directpatientrecord.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hattiesburg Clinic PA

  • Multi-Specialty Clinic/Center
  • Hattiesburg, MS
  • NPI 1740213446
  Medicare reassignment Care Compare group NPD
• Forrest County General Hospital

  • Psychiatric Hospital Unit
  • Hattiesburg, MS
  • NPI 1295837631
  Medicare reassignment NPD
• Forrest County General Hospital

  dba Highland Center for Women's Health RHC

  • Rural Health Clinic/Center
  • Picayune, MS
  • NPI 1043820426
  NPD
• Forrest County General Hospital

  dba Jefferson Davis Rural Health Clinic

  • Rural Health Clinic/Center
  • Prentiss, MS
  • NPI 1689952707
  NPD
• Hattiesburg Clinic, PA

  dba Flowood Primary Care

  • Primary Care Clinic/Center
  • Flowood, MS
  • NPI 1912600354
  NPD
• Hattiesburg Clinic, PA

  dba Laurel Dialysis Unit

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Laurel, MS
  • NPI 1245263540
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Forrest County General Hospital

  • General Acute Care Hospital
  • Hattiesburg, MS
  • NPI 1225041809
  Care Compare affiliation
• Forrest County General Hospital

  • Home Health Agency
  • Hattiesburg, MS
  • NPI 1336256700
  Care Compare affiliation
• Home Health Care Systems, Inc.

  dba Enhabit Home Health & Hospice

  • Home Health Agency
  • Hattiesburg, MS
  • NPI 1760416754
  Care Compare affiliation
• Leaf River Home Health Care, LLC

  • Home Health Agency
  • Richton, MS
  • NPI 1770521072
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1235521923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-264-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 PARKWAY LN",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394653035",
            "telephone_number": "601-544-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "WILLIAM",
        "middle_name": "PHILLIP",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-04",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "28846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Ezell
• Phillip Matthew Ezell, FNP-BC, AGACNP-BC
• Lorelei Lucas Farr, PHARM.D.
• Marcus Donald Finch
• Fit Jam LLC (Visiting Angels)
• Sara E Foster, MS, RD, LD
• G G Morrison LLC (Morrison Medical Specialties)
• Shawnta Senice Gandy
• Lauren O'Neal Garner, FNP-C
• Allison Garrett, NP

• Family Medicine Physician in Petal, MS
• Providers in Petal, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.