Provider Demographics
NPI:1023219961
Name:FOSTER, MICHAEL (SA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110339
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222-0339
Mailing Address - Country:US
Mailing Address - Phone:615-831-3711
Mailing Address - Fax:615-831-3713
Practice Address - Street 1:5716 HICKORY PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8546
Practice Address - Country:US
Practice Address - Phone:615-831-3711
Practice Address - Fax:615-831-3713
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3218246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant