MEDICARE: BRIAN DOUGLAS FOOR PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	002500	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033190723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DOUGLAS FOOR PA

Provider Business Mailing Address
First Line	:	6600 VAN AALST BLVD BLDG 9250
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	706-408-3566
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 VAN AALST BLVD BLDG 9250
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	706-408-3356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	02/23/2021

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