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General NPI Number Information
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NPI Number | 1083597876
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Entity Type | Individual
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Provider Name | CYNTHIA ANN FOUNTAIN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 909 ROLLO DOMINO CIR
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City | EVANS
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State | GA
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Zip | 30809-3485
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Country | US
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Telephone | 706-814-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 909 ROLLO DOMINO CIR
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City | EVANS
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State | GA
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Zip | 30809-3485
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Country | US
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Telephone | 706-750-8617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN174712
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN174712
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | NULL
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