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General NPI Number Information
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NPI Number | 1184623720
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Entity Type | Individual
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Provider Name | GRANT ALLAN FOSTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 58 GRACE CT
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4812
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Country | US
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Telephone | 912-727-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 58 GRACE CT
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4812
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Country | US
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Telephone | 912-727-3393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 045787
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GFE70203
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License Number State | CA
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