Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 14858 | MD |
NPI | 1003214669 |
---|---|
Provider Name | Judith Foster |
First Address | Bonaire, GA 31005-3588 |
Second Address | Bonaire, GA 31005-3588 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2014 |
Last Update Date | 15/12/2014 |