Provider Demographics
NPI:1316001985
Name:FORTIN, TROY REED (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:REED
Last Name:FORTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 MEDLOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE C-300
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8172
Mailing Address - Country:US
Mailing Address - Phone:770-476-9626
Mailing Address - Fax:770-476-1310
Practice Address - Street 1:6000 MEDLOCK BRIDGE PKWY
Practice Address - Street 2:SUITE C-300
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8172
Practice Address - Country:US
Practice Address - Phone:770-476-9626
Practice Address - Fax:770-476-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005857111NR0200X, 111NS0005X
GACHIRO005857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001296OtherBCBS
GA001296OtherBCBS