Individual
JEAN M FORTGANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3720 DAVINCI CT, NORCROSS, GA 30092-7627
(770) 582-3838
Mailing address
5145 MCINTOSH DR, CUMMING, GA 30040-9680
(770) 582-3838
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN113594 NP
GA
Other
Enumeration date
01/10/2007
Last updated
07/08/2007
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