Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY002944 | GA |
N | 103TC0700X | Clinical Psychologist | PSY002944 | GA |
N | 102L00000X | Psychologist | PSY002944 | GA |
N | 103T00000X | Psychologist | PSY002944 | GA |
N | 103G00000X | Clinical Psychologist | PSY002944 | GA |
N | 103TC0700X | Clinical Psychologist | PSY002944 | GA |
N | 103TR0400X | Rehabilitation Psychologist | PSY002944 | GA |
NPI | 1083669899 |
---|---|
Provider Name | Dr. Robert Alvin Foster III |
First Address | Macon, GA 31209-7924 |
Second Address | Macon, GA 31210-2587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q65521 | (02) | GA |