MICHAEL MCKINLEY FOUNTAIN (NPI# 1073023115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073023115 |
| Entity Type | Individual |
| Full Name | MICHAEL MCKINLEY FOUNTAIN |
| Credential | NP-C |
| Practice Address |
1120 Indian Dr Ste C Eastman GA 31023-7671 |
| Mailing Address |
1110 Hillcrest Pkwy Ste C Dublin GA 31021-3688 |
| Practice Telephone | 4783741778 |
| Practice Fax Number | 4783741727 |
| Mailing Telephone | 4782962800 |
| Mailing Fax Number | 4782962801 |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2017-10-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN240666 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346532843 | Michael D Fountain | Counselor | 1870 Roble Drive, Atlanta, GA 30349-9117 | 2011-05-03 |
| 1023260205 | Michael Warren Fountain | Urology | 1210 Waterman Way, Tavares, FL 32778-5229 | 2008-10-19 |
| 1063518751 | Michael Fountain | Dentist | 2776 Ringgold Rd, Fort Sill Dentac, Fort Sill, OK 73503-6300 | 2006-09-16 |
| Street Address |
1120 INDIAN DR STE C |
| City | EASTMAN |
| State | GA |
| Zip Code | 31023-7671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922404896 | Fasttrack Immediate Care of Eastman LLC | General Practice | 1120 Indian Dr Ste C, Eastman, GA 31023-7671 | 2014-11-05 |
| 1578163648 | Candace H Brown | Nurse Practitioner | 1120 Indian Dr Ste C, Eastman, GA 31023-7671 | 2020-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821555913 | Community Service Board of Middle Georgia | Day Training, Developmentally Disabled Services | 1444 Morgan Creek Dr, Eastman, GA 31023 | 2019-02-25 |
| 1174832232 | Lynetta Davies | Counselor | 17 Tanner Dr, Eastmon, GA 31023 | 2010-10-06 |
| 1467774380 | Dustin Phillip Smith | Chiropractor | 285 Plaza Avenue, Eastman, GA 31023 | 2010-02-19 |
| 1639311145 | D&b Home Care Inc | Durable Medical Equipment & Medical Supplies | 714 Medical Center Drive, Eastman, GA 31023 | 2009-03-30 |
| 1427273465 | Hospice Care Options Inc | Hospice Care, Community Based | 715 Legion Dr, Eastman, GA 31023 | 2007-04-16 |
| 1740318625 | Dana W Mullis | Dentist | 1003 Plaza Ave, Eastman, GA 31023 | 2007-03-01 |
| 1285787630 | 801 Legion LLC | Skilled Nursing Facility | 815 Legion Dr, Eastman, GA 31023 | 2007-01-19 |
| 1396813317 | Womens Health PC | Obstetrics & Gynecology | 821 Plaza Ave, Suite B, Eastman, GA 31023 | 2006-11-30 |
| 1932294170 | John D Roberts | Ophthalmology | 917 Plaza Avenue, Eastman, GA 31023 | 2006-10-04 |
| 1215030978 | Georgia Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 535 Oak St, Eastman, GA 31023 | 2006-09-07 |
| Find all providers in zip 31023 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760021414 | Lisa June Hardy | Nurse Practitioner | 113 Log Cabin Rd, Eastman, GA 31023-2404 | 2019-12-29 |
| 1528423639 | Kristen Nicole Bryant | Nurse Practitioner | 1120 Indian Dr, Eastman, GA 31023-7670 | 2015-12-17 |
| 1306233929 | Vickie Locke | Nurse Practitioner | 1061 Woodvalley Dr, Eastman, GA 31023-7512 | 2015-04-21 |
| 1982740957 | Joy Scarborough | Nurse Practitioner | 1112 Plaza Ave Ste B, Eastman, GA 31023-9012 | 2007-01-29 |
| 1578163648 | Candace H Brown | Nurse Practitioner | 1120 Indian Dr Ste C, Eastman, GA 31023-7671 | 2020-10-28 |
| 1144871260 | Britney Ward Smith | Nurse Practitioner | 1120 Indian Dr, Eastman, GA 31023-7670 | 2019-09-20 |
| 1659923076 | Tammie Dianne Oliver | Nurse Practitioner | 1085 Plaza Ave, Eastman, GA 31023-9102 | 2019-07-16 |
| 1316509771 | Brianna Jessup Crummey | Nurse Practitioner | 911 Plaza Ave Ste C, Eastman, GA 31023-6786 | 2019-07-05 |
| 1700362878 | Amanda Llyn Parkerson | Nurse Practitioner | 1223 Plaza Ave, Eastman, GA 31023-6763 | 2018-07-12 |
| 1346747664 | Catherine Michelle Moulton | Nurse Practitioner | 817 Griffin Ave, Eastman, GA 31023-6718 | 2018-04-12 |
| Find all providers in EASTMAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.