Healthcare Provider Details

I. General information

NPI: 1013900976
Provider Name (Legal Business Name): D. TERRENCE FOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEDICAL BLVD
STOCKBRIDGE GA
30281-5086
US

IV. Provider business mailing address

PO BOX 824
MORROW GA
30260-0824
US

V. Phone/Fax

Practice location:
  • Phone: 678-284-4000
  • Fax: 678-284-6500
Mailing address:
  • Phone: 678-284-4000
  • Fax: 678-284-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number49232
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number49232
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number49232
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: