Provider Demographics
NPI:1124180179
Name:FOSTER, CYNTHIA LING
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LING
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HART CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-3703
Mailing Address - Country:US
Mailing Address - Phone:404-863-0108
Mailing Address - Fax:770-445-0994
Practice Address - Street 1:205 HART CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-3703
Practice Address - Country:US
Practice Address - Phone:404-863-0108
Practice Address - Fax:770-445-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10051963OtherAMERIGROUP CMO