Basic Information
| Provider Information | |||||||||
| NPI: | 1851602494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORSYTHE | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | EMILINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 PEACHTREE DUNWOODY RD 215 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303425024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704554009 | ||||||||
| FaxNumber: | 7704554065 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR RM N1181 | ||||||||
| Address2: | DEPARTMENT OF PM&R | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665165 | ||||||||
| FaxNumber: | 9198430164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 165785 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 174400000X | 72260 | GA | Y | Other Service Providers | Specialist |
No ID Information.