Provider Demographics
NPI:1528737947
Name:FORTANBARY, JOYCE ELIZABETH (APC)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:FORTANBARY
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 POWERS FERRY ROAD SE BUILDING 22, SUITE 300
Mailing Address - Street 2:BUILDING 22, SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:678-249-9784
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY ROAD SE BUILDING 22, SUITE 300
Practice Address - Street 2:BUILDING 22, SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:678-249-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC008022OtherAPC