Fountain, Raetta B
Fountain, Raetta B is an individual health care provider with primary practice located at 2465 Emerald Place , Greenville NC 27834-5785. She recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as her primary health care specialty. Fountain, Raetta B can be contacted via phone (252) 758-2424.Contact Information
Primary practice address
2465 Emerald Place
Greenville NC 27834-5785
Phone: (252) 758-2424
Fax: (252) 758-0424
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 00025122 | Alabama |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 9400570 | North Carolina |
Profile Details
| NPI number | 1487643854 |
|---|---|
| LBN Legal business name | Fountain, Raetta B |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2005 |
| Last updated | Jul 8th, 2007 - about 18 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 | 1487643854 | NPPES |
| North Carolina | MEDICAID | 5903770 |
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