Individual
MR. RICHARD JOHN PHILIP FONTIMAYOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3651 WHEELER RD, AUGUSTA, GA 30909-6521
(706) 651-3232
Mailing address
2107 WHITNEY SOUTH DR, AUGUSTA, GA 30904-6552
(706) 877-1275
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7785
GA
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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