NPI age
13 years
Enumerated 2012-08-14
● Active Type 2 · Organization
Fountain Of Youth MD Llc
Fountain Of Youth MD Llc is 1 of 661 general practice organizations in Georgia.
Primary specialty
General Practice
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Danan
Owner
Last NPPES update
2014-05-22
Source: monthly bulk 2026-05
How this organization compares
Across 661 active general practice providers in Georgia.
NPI age
13 years
≈ at median (14 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2012 → 2026
2012-08Enumerated in NPPES
2012
2026
Where they practice
Primary practice location
200 Galleria Pkwy Se, Suite 100
Atlanta, GA 303395918
Mailing address
200 Galleria Pkwy Se, Suite 100
Atlanta, GA 303395918
Authorized official
Offer Danan
Owner
📞 7706955500
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Krystal Allen, FNP-C Nurse Practitioner NPI 1740782002
- Hema Hebbar, O.D Optometrist NPI 1356542765
- Ross Levine, D.M.D. Dentist NPI 1447510557
- Anita Vadria Physician Assistant NPI 1194124966
Specialties
-
General Practice PrimaryA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Practice context
Multi-provider organization. 4 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.