Fountain, John A.
Fountain, John A. is an individual health care provider with primary practice located at 1349 Milstead Rd Ne , Conyers GA 30012-3871. He recently has 6 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Fountain, John A. can be contacted via phone (770) 922-1716.Contact Information
Primary practice address
1349 Milstead Rd Ne
Conyers GA 30012-3871
Phone: (770) 922-1716
Fax: (770) 760-9504
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 021688 | Georgia |
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | 021688 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | 021688 | Georgia |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 021688 | Georgia |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 021688 | Georgia |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | 021688 | Georgia |
Profile Details
| NPI number | 1629076906 |
|---|---|
| LBN Legal business name | Fountain, John A. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2005 |
| Last updated | Apr 23rd, 2015 - about 10 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 | 1629076906 | NPPES |
| Georgia | Other | 531562 | BCBS OF GA |
| Georgia | MEDICAID | 00263051C | BCBS OF GA |
| Georgia | Other | 070007907 | BCBS OF GA |
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