MEDICARE: DR. GRANT ALLAN FOSTER M.D.

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	207Q00000X	Family Medicine Physician	045787	GA
2	207Q00000X	Family Medicine Physician	GFE70203	CA

General Provider Information

NPI Number	:	1184623720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRANT ALLAN FOSTER M.D.

Provider Business Mailing Address
First Line	:	58 GRACE CT
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-4812
Country	:	US
Telephone Number	:	912-727-3393
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 GRACE CT
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-4812
Country	:	US
Telephone Number	:	912-727-3393
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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