Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 008021 | GA |
NPI | 1154704195 |
---|---|
Provider Name | Dr. Jessica Forcillo |
First Address | Atlanta, GA 30308-2208 |
Second Address | Atlanta, GA 30308-2208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 07/09/2015 |