Healthcare Provider Details

I. General information

NPI: 1972115616
Provider Name (Legal Business Name): HANNAH GRACE FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 08/22/2020
Certification Date: 08/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 WIREGRASS DR
DOTHAN AL
36301-9500
US

IV. Provider business mailing address

229 DOZIER DR APT 436
TROY AL
36081-3044
US

V. Phone/Fax

Practice location:
  • Phone: 334-791-4611
  • Fax:
Mailing address:
  • Phone: 334-791-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: