Provider Demographics
NPI:1063772309
Name:ORTEGA-FONTE, KRISTINE AURA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:AURA
Last Name:ORTEGA-FONTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5324
Mailing Address - Country:US
Mailing Address - Phone:404-251-1600
Mailing Address - Fax:
Practice Address - Street 1:4791 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5324
Practice Address - Country:US
Practice Address - Phone:404-251-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31401207Q00000X
GA87451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL180293Medicaid
AL511-70128OtherBCBS
AL180293Medicaid
AL140903Medicaid
AL529906610 GROUPMedicaid
AL511-27771OtherBCBS
AL102I082506Medicare PIN