Individual
KIMBERLY TERESA FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD,MS
Contact information
Practice address
GRU, 1120 15TH STREET, AUGUSTA, GA 30912-0001
(706) 834-0190
Mailing address
450 RAILROAD AVE, STE 1-D, NORTH AUGUSTA, SC 29841-3782
(801) 671-0933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207R0000X
TN
Other
Enumeration date
07/14/2009
Last updated
07/07/2015
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