Provider Demographics
NPI:1790847044
Name:FOSTON, TENITA PHILLIPS (FNP-C)
Entity Type:Individual
Prefix:
First Name:TENITA
Middle Name:PHILLIPS
Last Name:FOSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 COOLWATER CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5274
Mailing Address - Country:US
Mailing Address - Phone:404-991-4086
Mailing Address - Fax:770-609-6730
Practice Address - Street 1:1365 CLIFTON RD NE # B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4271
Practice Address - Fax:404-778-2925
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119706NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily