Individual
MRS. ATHENA JOANN FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
340 HODGSON CT, SUITE 2, SAVANNAH, GA 31406-1520
(912) 629-2290
(912) 629-2291
Mailing address
PO BOX 14417, SAVANNAH, GA 31416-1417
(912) 629-2290
(912) 629-2291
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN101700
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003129391A
—
GA
Enumeration date
04/25/2007
Last updated
08/19/2014
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