National Provider Identifier Database

FOUNTAIN OF YOUTH MD LLC
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

FOUNTAIN OF YOUTH MD LLC
200 GALLERIA PKWY SE
SUITE 100
ATLANTA, GA30339-5918
Phone: 770-695-5500
Fax: 800-814-3301
Website:
Specialty Taxonomy Code
* General Practice 208D00000X

* Indicates primary specialty

NPI Profile & details for FOUNTAIN OF YOUTH MD LLC

NPI Number 1649527284
Legal business name
LBN
FOUNTAIN OF YOUTH MD LLC
Authorized official OFFER DANAN - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 08/14/2012
Last updated 05/22/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers n/a

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.

Reviews for FOUNTAIN OF YOUTH MD LLC

There are currently no reviews for FOUNTAIN OF YOUTH MD LLC


NPIdb - Home
v2.201