Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 49232 | GA |
NPI | 1013900976 |
---|---|
Provider Name | Dr. D. Terrence Foster |
First Address | Morrow, GA 30260-0824 |
Second Address | Stockbridge, GA 30281-5086 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00883154B | (05) | GA |
H28198 | (02) | GA |