MEDICARE: VIRGINIA RUTLEDGE FORNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	044218	GA
2	207N00000X	Dermatology Physician	044218	GA
3	207NS0135X	Procedural Dermatology Physician	044218	GA

General Provider Information

NPI Number	:	1316941644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA RUTLEDGE FORNEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 52226
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30355-0226
Country	:	US
Telephone Number	:	404-816-7900
Fax Number	:	404-816-7929

Provider Business Practice Location Address
First Line	:	3131 MAPLE DR NE
Second Line	:	SUITE102
City	:	ATLANTA
State	:	GA
Zip	:	30305-2515
Country	:	US
Telephone Number	:	404-816-7900
Fax Number	:	404-816-7929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/07/2009

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