Provider Demographics
NPI:1366513871
Name:FORTH, AMY LOUISE (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
Last Name:FORTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 THE EXCHANGE SE STE 105
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7401
Mailing Address - Country:US
Mailing Address - Phone:678-449-5759
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE 105
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7418
Practice Address - Country:US
Practice Address - Phone:678-449-5759
Practice Address - Fax:770-955-8060
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor