Provider Demographics
NPI:1972751600
Name:FOUNTAIN, JOYCE LYNN (RRT)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LYNN
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 OLD MILL DR
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-9023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 HARPER AVE
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524-7948
Practice Address - Country:US
Practice Address - Phone:919-963-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5776227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered