Provider Demographics
NPI:1891912895
Name:FOSTER, MARGO J (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:J
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CHICKASAW RUN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5712
Mailing Address - Country:US
Mailing Address - Phone:770-926-6627
Mailing Address - Fax:
Practice Address - Street 1:140 VANN ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7297
Practice Address - Country:US
Practice Address - Phone:770-425-5525
Practice Address - Fax:404-367-9911
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000187133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered