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General NPI Number Information
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NPI Number | 1922732593
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Entity Type | Individual
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Provider Name | MADELEINE M FONTANA PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 1800 HOWELL MILL RD NW STE 175
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City | ATLANTA
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State | GA
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Zip | 30318-0924
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Country | US
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Telephone | 404-607-1777
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Fax | 404-607-1799
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Provider Business Mailing Address
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Address Line | 1800 HOWELL MILL RD NW STE 175
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City | ATLANTA
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State | GA
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Zip | 30318-0924
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Country | US
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Telephone | 404-607-1777
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Fax | 404-607-1799
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 11065
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License Number State | GA
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