Healthcare Provider Details

I. General information

NPI: 1083669899
Provider Name (Legal Business Name): ROBERT ALVIN FOSTER III PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 NORTHSIDE DR
MACON GA
31210-2587
US

IV. Provider business mailing address

PO BOX 7924
MACON GA
31209-7924
US

V. Phone/Fax

Practice location:
  • Phone: 478-201-6636
  • Fax:
Mailing address:
  • Phone: 478-201-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY002944
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002944
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY002944
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY002944
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: