Provider Demographics
NPI:1578596029
Name:HALLIBURTON-FOSTER, NADINE SONJA (MD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:SONJA
Last Name:HALLIBURTON-FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NADINE
Other - Middle Name:SONJA
Other - Last Name:HALLIBURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2575 PEACHTREE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7562
Mailing Address - Country:US
Mailing Address - Phone:770-888-8777
Mailing Address - Fax:770-888-8779
Practice Address - Street 1:2575 PEACHTREE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-888-8777
Practice Address - Fax:770-888-8779
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27038207Q00000X
GA060079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA237071919AMedicaid
GA237071919AMedicaid
SC131230Medicare UPIN