MEDICARE: MR. JOHN I FOSTER III MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	037539	GA

General Provider Information

NPI Number	:	1356336655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN I FOSTER III MD

Provider Business Mailing Address
First Line	:	5555 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 215
City	:	ATLANTA
State	:	GA
Zip	:	30342-1703
Country	:	US
Telephone Number	:	770-455-4009
Fax Number	:	770-455-4065

Provider Business Practice Location Address
First Line	:	5555 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 215
City	:	ATLANTA
State	:	GA
Zip	:	30342-1703
Country	:	US
Telephone Number	:	770-455-4009
Fax Number	:	770-455-4065

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	08/09/2012

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