Individual
MRS. EMILY DAFFRON FORTENBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
604 STONE AVE, TALLADEGA, AL 35160-2217
(256) 458-2155
Mailing address
3657 HALL DR, SOUTHSIDE, AL 35907-0817
(256) 458-2155
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1-125066
AL
363L00000X
Nurse Practitioner
1206590
TX
363LA2100X
Acute Care Nurse Practitioner
GAA-NP004269
GA
363LG0600X
Gerontology Nurse Practitioner
Primary
1-125066
AL
Other
Enumeration date
10/15/2018
Last updated
03/23/2026
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