Organization
FOUNTAIN FAMILY MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANNE MACDONALD (OFFICE MANAGER)
(904) 262-9075
Entity
Organization
Contact information
Practice address
11701-32 SAN JOSE BOULEVARD, SUITE 103, JACKSONVILLE, FL 32223
(904) 262-9075
Mailing address
11701-32 SAN JOSE, SUITE 103, JACKSONVILLE, FL 32223
(904) 262-9075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/19/2007
Last updated
08/28/2012
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