Healthcare Provider Details

I. General information

NPI: 1295134492
Provider Name (Legal Business Name): APRIL JILES FORTENBERRY PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 QUARTZ DR STE 103B
VILLA RICA GA
30180-3201
US

IV. Provider business mailing address

20 HERRELL RD
VILLA RICA GA
30180-5527
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-3530
  • Fax: 770-812-3531
Mailing address:
  • Phone: 770-812-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN106665
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP106665
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN106665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: