Organization
FOUNTAIN OF YOUTH MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OFFER DANAN (OWNER)
(770) 695-5500
Entity
Organization
Contact information
Practice address
200 GALLERIA PKWY SE, SUITE 100, ATLANTA, GA 30339-5918
(770) 695-5500
(800) 814-3301
Mailing address
200 GALLERIA PKWY SE, SUITE 100, ATLANTA, GA 30339-5918
(770) 695-5500
(800) 814-3301
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/14/2012
Last updated
05/22/2014
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