| NPI | 1255404620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN E FOUNTAIN Sole Owner Practitioner 850-626-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 50330) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-03-07 |