Provider Demographics
NPI:1275636375
Name:FOSTER, CHARLES EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2503
Mailing Address - Country:US
Mailing Address - Phone:478-474-3883
Mailing Address - Fax:478-474-3884
Practice Address - Street 1:3323 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2503
Practice Address - Country:US
Practice Address - Phone:478-474-3883
Practice Address - Fax:478-474-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2884111N00000X
NC1920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCBBNMedicare ID - Type Unspecified
U17710Medicare UPIN