Individual
DR. JOHN E FONTAINE IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1855 CRANE RIDGE DR STE A, JACKSON, MS 39216-4944
(601) 982-8700
(601) 366-3906
Mailing address
1855 CRANE RIDGE DR STE A, JACKSON, MS 39216-4944
(601) 982-8700
(601) 366-3906
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
30429
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00011417
—
MS
Enumeration date
09/06/2006
Last updated
07/08/2007
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