Nino Renzo Renzo Fornasini, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

48628 Issued in GA

Practice address

3985 Steve Reynolds Blvd
BLDG I
Norcross, GA 30093-3035

Phone

(770) 622-3948

Fax

(770) 622-4879

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nfornasini30409@choa.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Care Clinic P.C.

  • Clinic/Center
  • Norcross, GA
  • NPI 1245406438

  Pediatrics

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1063586170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3985 STEVE REYNOLDS BLVD",
            "address_2": "BLDG I",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300933035",
            "telephone_number": "770-622-3948",
            "fax_number": "770-622-4879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3985 STEVE REYNOLDS BLVD",
            "address_2": "BLDG I",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300933035",
            "telephone_number": "770-622-3948",
            "fax_number": "770-622-4879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNASINI",
        "first_name": "NINO RENZO",
        "middle_name": "RENZO",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "48628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000879755A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Michelle Fobb
• Focal Point Optical
• Megan Ciandra Ford
• Shakirah Forde, LCSW
• Angelica Maria Forero, NP
• Rakeisha Nichole Forte, NP-C
• Jean M Fortgang, NP
• Heather Nicole Forward, LCSW
• Deshun Foster, BCBA
• Asiah Foulks

• Pediatrics Physician in Norcross, GA
• Providers in Norcross, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.