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FOUNTAIN OF YOUTH MD LLC NPI 1649527284


NPI Information

NPI: 1649527284
Provider Name: FOUNTAIN OF YOUTH MD LLC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
200 GALLERIA PKWY SE
SUITE 100
ATLANTA, GA
ZIP 30339
Phone: (770) 695-5500
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FOUNTAIN OF YOUTH MD LLC is a general practice in Atlanta, GA. FOUNTAIN OF YOUTH MD LLC NPI is 1649527284. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

200 GALLERIA PKWY SE
SUITE 100
ATLANTA, GA
ZIP 30339-918
Phone: (770) 695-5500
Fax: (800) 814-3301

The provider's authorized official is Offer Danan .
The authorized official title is Owner and has the following contact phone number (770) 695-5500.

The enumeration date for this NPI number is 8/14/2012 and was last updated on 5/22/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208D00000XGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.