Healthcare Provider Details

I. General information

NPI: 1831411347
Provider Name (Legal Business Name): PATRICE M FOSTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 CANDLER RD
DECATUR GA
30032-6502
US

IV. Provider business mailing address

237 COBBLESTONE LN
MCDONOUGH GA
30252-6255
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2710
  • Fax:
Mailing address:
  • Phone: 177-084-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN521841L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN164573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: