Fortman, Kyle D

Fortman, Kyle D is an individual health care provider with primary practice located at 1968 Peachtree Rd Nw , Atlanta GA 30309-1281. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Fortman, Kyle D can be contacted via phone (404) 367-3014.

Contact Information

Primary practice address
1968 Peachtree Rd Nw Atlanta GA 30309-1281
Phone: (404) 367-3014
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1114 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 1114 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 009532 Georgia

Profile Details

NPI number 1598828923
LBN Legal business name Fortman, Kyle D
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 18th, 2006
Last updated Nov 18th, 2019 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598828923 NPPES
Tennessee MEDICAID 3379860
Tennessee MEDICAID 3662061
Tennessee Other 4075854

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