Individual
ELISA J LAFOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
408 N STATE OF FRANKLIN RD, SUITE 24, JOHNSON CITY, TN 37604-6089
(423) 431-1810
(423) 431-1811
Mailing address
408 N STATE OF FRANKLIN RD, SUITE 24, JOHNSON CITY, TN 37604-6089
(423) 431-1810
(423) 431-1811
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1788
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1509060
—
TN
05
—
1992738702
—
NC
05
—
1992738702
—
VA
05
—
7100247440
—
KY
01
—
P01224653
RAILROAD MEDICARE
TN
Enumeration date
07/08/2006
Last updated
02/15/2017
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