Healthcare Provider Details

I. General information

NPI: 1063824456
Provider Name (Legal Business Name): ZACHARY FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OLD PLEASANT GROVE RD SUITE 100
MOUNT JULIET TN
37122-3879
US

IV. Provider business mailing address

20 OLD PLEASANT GROVE RD SUITE 100
MOUNT JULIET TN
37122-3879
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4807
  • Fax: 615-758-4892
Mailing address:
  • Phone: 615-758-4807
  • Fax: 615-758-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: