Provider Demographics
NPI:1851602494
Name:FORSYTHE, NICOLE EMILINE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:EMILINE
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 CROSSWINDS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008
Mailing Address - Country:US
Mailing Address - Phone:423-580-4743
Mailing Address - Fax:770-455-4065
Practice Address - Street 1:BARBOUR ORTHOPEDICS AND SPORTS MEDICINE
Practice Address - Street 2:3240 NORTHEAST EXPRESSWAY SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:404-480-9330
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72260174400000X, 390200000X
NC165785390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No174400000XOther Service ProvidersSpecialist