Individual
JOSHUA SHANE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3031
(404) 616-1000
Mailing address
934 GARIBALDI ST SW, ATLANTA, GA 30310-3134
(470) 967-4841
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
RN247882
GA
Other
Enumeration date
11/15/2021
Last updated
02/08/2022
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