Provider Demographics
NPI:1972307247
Name:FONTAINE, NATALIE
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:IRVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 N OAK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3808
Mailing Address - Country:US
Mailing Address - Phone:479-225-0673
Mailing Address - Fax:
Practice Address - Street 1:114 E GENERAL SCREVEN WAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3014
Practice Address - Country:US
Practice Address - Phone:912-877-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist