Healthcare Provider Details

I. General information

NPI: 1720316219
Provider Name (Legal Business Name): HEATHER MCNAIR FOSTER RD, LDN, MED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ARTHUR DR
THOMASVILLE NC
27360-6275
US

IV. Provider business mailing address

200 ARTHUR DR
THOMASVILLE NC
27360-6275
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-2348
  • Fax:
Mailing address:
  • Phone: 336-475-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number872213
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: