Provider Demographics
NPI:1033824941
Name:FOSTER, MICHAEL BROOKS (NP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BROOKS
Last Name:FOSTER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 13TH ST NE UNIT 802
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5030
Mailing Address - Country:US
Mailing Address - Phone:601-757-8403
Mailing Address - Fax:
Practice Address - Street 1:4400 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2729
Practice Address - Country:US
Practice Address - Phone:404-977-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN316610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily