Fontaine, John E
Fontaine, John E is an sole proprietor health care provider with primary practice located at 1855 Crane Ridge Dr Ste A , Jackson MS 39216-4944. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as his primary health care specialty. Fontaine, John E can be contacted via phone (601) 982-8700.Contact Information
Primary practice address
1855 Crane Ridge Dr Ste A
Jackson MS 39216-4944
Phone: (601) 982-8700
Fax: (601) 366-3906
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 30429 | Mississippi |
Profile Details
| NPI number | 1093818064 |
|---|---|
| LBN Legal business name | Fontaine, John E |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 6th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093818064 | NPPES |
| Mississippi | MEDICAID | 00011417 |
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