Healthcare Provider Details

I. General information

NPI: 1124325535
Provider Name (Legal Business Name): JASON A FOERTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD DEPT OF
FORT BENNING GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD DEPT OF
FORT BENNING GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-2001
  • Fax:
Mailing address:
  • Phone: 762-408-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26892
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number84292
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: