Individual
ALEXIS BYRD FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
122 ALICE COLEMAN DRIVE, VIDALIA, GA 30474
(912) 805-2273
Mailing address
297 R T LANE, TARRYTOWN, GA 30470
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN274392
GA
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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