Provider Demographics
NPI:1003915190
Name:DRAKE-FORTE, GABRAELLA (MD)
Entity Type:Individual
Prefix:
First Name:GABRAELLA
Middle Name:
Last Name:DRAKE-FORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRAELLA
Other - Middle Name:
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400-C OLD MILTON PKWY
Mailing Address - Street 2:STE 490
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:678-297-0070
Mailing Address - Fax:678-297-0073
Practice Address - Street 1:3400-C OLD MILTON PKWY
Practice Address - Street 2:STE 490
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:678-297-0070
Practice Address - Fax:678-297-0073
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041106208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F41642Medicare UPIN
37BBFNPMedicare ID - Type Unspecified