Organization
FOUNTAIN BRIDGE SERVICES, LLC
Active
Organization
FOUNTAIN BRIDGE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M JOHNSON (PRESIDENT)
(404) 604-0092
Entity
Organization
Contact information
Practice address
456 TIORAM LN SE, SMYRNA, GA 30082-5239
(404) 604-0092
Mailing address
456 TIORAM LN SE, SMYRNA, GA 30082-5239
(404) 604-0092
(888) 741-5935
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
—
—
246Z00000X
Other Specialist/Technologist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/10/2012
Last updated
01/09/2013
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