Individual
LARRY M. FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2121A BELLEVUE RD, DUBLIN, GA 31021-2998
(478) 272-1190
Mailing address
2121A BELLEVUE RD, DUBLIN, GA 31021-2998
(478) 272-1190
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN063292
GA
Other
Enumeration date
07/24/2008
Last updated
07/24/2008
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