Healthcare Provider Details

I. General information

NPI: 1821133737
Provider Name (Legal Business Name): JENNIFER FLAMM FORTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 PARKLAKE DRIVE NW SUITE 430
ATLANTA GA
30345
US

IV. Provider business mailing address

3435 BULLOCH LAKE RD
LOGANVILLE GA
30052-8648
US

V. Phone/Fax

Practice location:
  • Phone: 404-800-5680
  • Fax: 678-712-7875
Mailing address:
  • Phone: 404-791-5840
  • Fax: 404-385-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number054718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: