Individual
DR. JOHN A. FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1349 MILSTEAD RD NE, CONYERS, GA 30012-3871
(770) 922-1716
(770) 760-9504
Mailing address
2400 BELLEVUE RD, SUITE 21-A, DUBLIN, GA 31021-2885
(478) 275-7202
(478) 274-8418
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
021688
GA
207ND0101X
MOHS-Micrographic Surgery Physician
021688
GA
207ND0900X
Dermatopathology Physician
021688
GA
207NP0225X
Pediatric Dermatology Physician
021688
GA
207NS0135X
Procedural Dermatology Physician
021688
GA
208D00000X
General Practice Physician
021688
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00263051C
—
GA
01
—
070007907
RAILROAD MEDICARE
GA
01
—
531562
BCBS OF GA
GA
Enumeration date
07/12/2005
Last updated
04/23/2015
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