Healthcare Provider Details

I. General information

NPI: 1184623720
Provider Name (Legal Business Name): GRANT ALLAN FOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 GRACE CT
RICHMOND HILL GA
31324-4812
US

IV. Provider business mailing address

58 GRACE CT
RICHMOND HILL GA
31324-4812
US

V. Phone/Fax

Practice location:
  • Phone: 912-727-3393
  • Fax:
Mailing address:
  • Phone: 912-727-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number045787
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGFE70203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: