Provider Demographics
NPI:1013900976
Name:FOSTER, D. TERRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:D. TERRENCE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-0824
Mailing Address - Country:US
Mailing Address - Phone:678-284-4000
Mailing Address - Fax:678-284-6500
Practice Address - Street 1:240 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5086
Practice Address - Country:US
Practice Address - Phone:678-284-4000
Practice Address - Fax:678-284-6500
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49232208100000X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00883154BMedicaid
GA00883154BMedicaid
GA00883154BMedicaid