Individual
FEDIA EVELINE FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9431 WATERS EDGE DR, JONESBORO, GA 30236-8033
(772) 646-8373
Mailing address
9431 WATERS EDGE DR, JONESBORO, GA 30236-8033
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
RN295917
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000000000
0000000000000
—
Enumeration date
07/01/2021
Last updated
07/01/2021
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