Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 044218 | GA |
N | 207NS0135X | Procedural Dermatology | 044218 | GA |
NPI | 1316941644 |
---|---|
Provider Name | Virginia Rutledge Forney |
First Address | Atlanta, GA 30355-0226 |
Second Address | Atlanta, GA 30305-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 07/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H20976 | (02) | GA |