DR. JOHN E FONTAINE IV (NPI# 1093818064) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093818064 |
| Entity Type | Individual |
| Full Name | DR. JOHN E FONTAINE IV |
| Credential | PH.D. |
| Practice Address |
1855 Crane Ridge Dr Ste A Jackson MS 39216-4944 |
| Practice Telephone | 6019828700 |
| Practice Fax Number | 6013663906 |
| Mailing Telephone | 6019828700 |
| Mailing Fax Number | 6013663906 |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
30429 | MS | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00011417 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730546508 | John Fontaine | Physical Therapist | 33900 Harper Ave, Suite 104, Clinton Township, MI 48035-4258 | 2016-01-25 |
| 1962424150 | John A Fontaine | Dentist | 435 Main St, Suite 2000, Fitchburg, MA 01420-8026 | 2006-07-24 |
| 1811945017 | John Fontaine | Internal Medicine | 219 N Broad St, 2nd Floor, Philadelphia, PA 19107-1519 | 2006-05-04 |
| Street Address |
1855 CRANE RIDGE DR STE A |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4944 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972840379 | Jbg Consulting | Psychologist | 6855 Squaw Creek Road, Jackson, WY 83001 | 2013-01-07 |
| 1184724569 | James B Austin | Psychologist | 1855 Crane Ridge Drive, Suite A, Jackson, MS 39216-4944 | 2006-09-25 |
| 1386285765 | Danny J Olmi | Psychologist | 2510 Lakeland Ter, Jackson, MS 39216-4702 | 2019-10-07 |
| 1376094532 | Jackson Family First | Psychologist | 125 Cedarwood Dr, Jackson, MS 39212-2208 | 2016-10-21 |
| 1053717694 | Chelsey M Wylde | Psychologist | 2863 Highway 45 Byp, Jackson, TN 38305-3618 | 2014-11-10 |
| 1184063505 | Diana J Whalen | Psychologist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2013-06-19 |
| 1942646161 | Melora Wiley | Psychologist | 2500 N State St, Jackson, MS 39216-4500 | 2013-05-14 |
| 1316290067 | Andres G Viana | Psychologist | 2500 N State St, Dept of Psychiatry, Jackson, MS 39216-4500 | 2012-10-18 |
| 1356625081 | Crystal S. Lim | Psychologist | 2500 N State St, Jackson, MS 39216-4500 | 2011-09-29 |
| 1619907771 | Dorothy Scattone | Psychologist | 2500 N State St, Jackson, MS 39216-4500 | 2006-07-04 |
| Find all providers in JACKSON | ||||
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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.