Provider Demographics
NPI:1619136959
Name:FOUNTAIN, JOEL ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROBERT
Last Name:FOUNTAIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-8505
Mailing Address - Country:US
Mailing Address - Phone:478-954-2188
Mailing Address - Fax:
Practice Address - Street 1:411 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-8505
Practice Address - Country:US
Practice Address - Phone:478-954-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine