Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Fountain of Youth MD LLC

Organization General Practice Physician · NPI 1649527284

Fountain of Youth MD LLC provides General Practice Physician services in Atlanta, Georgia. Registered with an NPI since 2012.

In the registry since
2012
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

200 Galleria Pkwy SE Ste 100
Atlanta, GA 30339-5918 Not confirmed with CMS for 12 years — call before visiting
Phone: (770) 695-5500
Fax: (800) 814-3301
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X

Record details

NPI number1649527284
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Offer Danan — Owner · (770) 695-5500
NPI enumeratedAugust 14, 2012
Last updated in NPPESMay 22, 2014
Mailing address200 Galleria Pkwy Se, Suite 100, Atlanta, GA 30339-5918

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