Provider Demographics
NPI:1013776426
Name:FORESTER, MARY CAROLINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLINE
Last Name:FORESTER
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 1:210 SHADOWLEDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3666
Mailing Address - Country:US
Mailing Address - Phone:770-331-5679
Mailing Address - Fax:
Practice Address - Street 1:210 SHADOWLEDGE LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3666
Practice Address - Country:US
Practice Address - Phone:770-331-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program