Healthcare Provider Details

I. General information

NPI: 1316001985
Provider Name (Legal Business Name): TROY REED FORTIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MEDLOCK BRIDGE PKWY SUITE C-300
JOHNS CREEK GA
30022-8172
US

IV. Provider business mailing address

6000 MEDLOCK BRIDGE PKWY SUITE C-300
JOHNS CREEK GA
30022-8172
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-9626
  • Fax: 770-476-1310
Mailing address:
  • Phone: 770-476-9626
  • Fax: 770-476-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO005857
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number005857
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number005857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: