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Individual

SHAW WENDI FORTUCHANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
110 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 376-6726
(770) 376-6727
Mailing address
110 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 376-6726
(770) 376-6727

Taxonomy

Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
66108
GA
2084P0800X
Psychiatry Physician
Primary
66108
GA
2084P0804X
Child & Adolescent Psychiatry Physician
66108
GA

Other

Enumeration date
03/21/2007
Last updated
08/18/2014
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