Individual
MRS. RAETTA B FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2465 EMERALD PLACE, GREENVILLE, NC 27834-5785
(252) 758-2424
(252) 758-0424
Mailing address
2465 EMERALD PLACE, GREENVILLE, NC 27834-5785
(252) 758-2424
(252) 758-0424
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
00025122
AL
207RG0100X
Gastroenterology Physician
Primary
9400570
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903770
—
NC
Enumeration date
10/19/2005
Last updated
07/08/2007
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