Individual
FANISHA Y PORTER-BEMPONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 GLENLAKE PKWY STE 200, ATLANTA, GA 30328-3488
(800) 767-4411
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
(262) 646-1049
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
82683
GA
2084P0800X
Psychiatry Physician
Primary
82683
GA
2084P0804X
Child & Adolescent Psychiatry Physician
82683
GA
Other
Enumeration date
05/06/2013
Last updated
04/12/2023
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