Individual
MRS. TASIA FORTUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4500 HOSPITAL BLVD STE 320, ROSWELL, GA 30076-0001
(770) 410-4520
(770) 410-4525
Mailing address
4500 HOSPITAL BLVD STE 320, ROSWELL, GA 30076-0001
(770) 410-4520
(770) 410-4525
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11303
GA
363A00000X
Physician Assistant
3607
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4455PA
—
SC
Enumeration date
08/15/2019
Last updated
02/20/2023
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