Individual
CYNTHIA ANN FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
909 ROLLO DOMINO CIR, EVANS, GA 30809-3485
(706) 814-0705
Mailing address
909 ROLLO DOMINO CIR, EVANS, GA 30809-3485
(706) 750-8617
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN174712
GA
171400000X
Health & Wellness Coach
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN174712
GA
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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