Healthcare Provider Details

I. General information

NPI: 1497248520
Provider Name (Legal Business Name): DOMINIQUE NICOLE HOWARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOMINIQUE NICOLE FORTUNE

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 WINDWARD PLZ STE F411
ALPHARETTA GA
30005-8771
US

IV. Provider business mailing address

3070 WINDWARD PLZ STE F411
ALPHARETTA GA
30005-8771
US

V. Phone/Fax

Practice location:
  • Phone: 678-713-7516
  • Fax:
Mailing address:
  • Phone: 678-713-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN299261
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN299261
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09895
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: