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1497232565
JACOB J FOUNTAIN
GREENVILLE, SC
NPI
1497232565
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: SC 21977)
Enumeration Date
2018-07-23
Last Update Date
2018-07-23
Business Address
Mr. JACOB J FOUNTAIN FNP
225 ENTERPRISE BLVD SUITE 101
GREENVILLE, SC 29615
Phone number: 864-454-8120
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Mailing Address
Mr. JACOB J FOUNTAIN FNP
100 W FARIS RD
GREENVILLE, SC 29605-3002
Phone number: 917-696-6622
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