Samuel L. Fort

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

9501242 Issued in NC

Practice address

203B Mocksville Ave
Salisbury, NC 28144-3325

Phone

(704) 636-0971

Fax

(704) 636-8854

NPI assigned

Apr 13, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

• Epiphany Dermatology PA

  • Dermatology Physician
  • Waco, TX
  • NPI 1043615263
  Medicare reassignment

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1841254166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2145",
            "address_2": "203 B MOCKSVILLE AVENUE",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281452145",
            "telephone_number": "704-636-0971",
            "fax_number": "704-636-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203B MOCKSVILLE AVE",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281443325",
            "telephone_number": "704-636-0971",
            "fax_number": "704-636-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT",
        "first_name": "SAMUEL",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "NC",
            "license": "9501242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "33148",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8933148",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Marie Flynn, DPT
• Food Lion LLC
• Food Lion LLC
• Vivian Kimberly Forbes
• Antoinette Ford
• Donald Richard Fortner Jr., DMD
• Sandy Lee Fortson, PTA
• Audassi Yvonne Foster
• Diana Marie Foster, MSN, APRN, FNP-C
• Bertrand Fote, MD

• Legal Medicine in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Legal Medicine in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.