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General NPI Number Information
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NPI Number | 1093436842
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Entity Type | Organization
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Legal Business Name | FOUNTAINS OF ASHEVILLE, LLC
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 70 PEACHTREE RD STE 120
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City | ASHEVILLE
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State | NC
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Zip | 28803-3391
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Country | US
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Telephone | 828-579-3640
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Fax | 828-579-3641
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Provider Business Mailing Address
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Address Line | 70 PEACHTREE RD STE 120
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City | ASHEVILLE
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State | NC
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Zip | 28803-3391
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Country | US
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Telephone | 828-579-3640
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Fax | 828-579-3641
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | GEORGE WADE PHILLIPS
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Credential |
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Telephone | 828-579-3640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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