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Contact Information

DARRYL FONTAINE, MD
4105 FORT HENRY DRIVE
SUITE 207
KINGSPORT, TN37663
 Phone: 423-239-5833
 Fax: 423-239-9789
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for DARRYL FONTAINE · (Male)

NPI Number 1023000429
Status Active
Credentials MD
Entity Individual
Enumeration date 08/22/2005
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 20124
  • KY Medicaid 64911142
  • NC Medicaid 890576L
  • TN Medicaid 3051034
  • VA Medicaid 5747040
  • WV Medicaid 0221312000
  • Other 063263 ANTHEM BCBS
  • Other 3046989 BLUE SHIELD OF TN
  • Other TN0100 JOHN DEERE
  • Other 00013859 NHC CARE ADMINISTRATORS
  • Other 100011235 PHP TENNCARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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