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General NPI Number Information
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NPI Number | 1356260780
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Entity Type | Individual
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Provider Name | DR. ALEXIS FORTE'-TATUM
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Gender | Female
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 3056 NEW MACLAND RD
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-1737
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Country | US
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Telephone | 678-340-6010
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Fax | 678-881-4111
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Provider Business Mailing Address
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Address Line | 3056 NEW MACLAND RD
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-1737
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Country | US
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Telephone | 678-340-6010
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Fax | 678-881-4111
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | RN169974
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | RN169974
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN080083
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | RN169974
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | RN169974
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | LPN080083
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | LPN080083
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License Number State | GA
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