Individual
MR. MADISON LEE FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, AGNP-C
Contact information
Practice address
3200 NORTHLINE AVE STE 250, GREENSBORO, NC 27408-7619
(336) 689-0669
Mailing address
4406 HOPEWELL CHURCH RD, TRINITY, NC 27370-7348
(336) 689-0669
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5020174
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
5020174
NC
363LS0200X
School Nurse Practitioner
304292
NC
Other
Enumeration date
01/13/2023
Last updated
07/02/2024
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