Healthcare Provider Details

I. General information

NPI: 1871112714
Provider Name (Legal Business Name): DR. NICOLE FORTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WADE GREEN RD NW STE 204
KENNESAW GA
30144-1808
US

IV. Provider business mailing address

1515 BLACKWELL RD
MARIETTA GA
30066-2905
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-2799
  • Fax:
Mailing address:
  • Phone: 785-407-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011141
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: