Individual
MR. JACOB J FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
225 ENTERPRISE BLVD, SUITE 101, GREENVILLE, SC 29615
(864) 454-8120
Mailing address
100 W FARIS RD, GREENVILLE, SC 29605-3002
(917) 696-6622
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21977
SC
Other
Enumeration date
07/23/2018
Last updated
07/23/2018
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