Organization
THE FOUNTAIN CENTER FOR PREVENTATIVE MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELINA JOHNSON NP (NURSE PRACTITIONER/MEMBER)
(615) 420-6884
Entity
Organization
Contact information
Practice address
110 GLANCY ST # 107, GOODLETTSVILLE, TN 37072-2326
(615) 420-6884
Mailing address
110 GLANCY ST # 107, GOODLETTSVILLE, TN 37072-2326
(615) 420-6884
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/26/2010
Last updated
04/26/2010
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