Provider Demographics
NPI:1023837952
Name:FOSTER, DEANNA (IBCLC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BELMONT DR SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-7513
Mailing Address - Country:US
Mailing Address - Phone:678-767-9224
Mailing Address - Fax:
Practice Address - Street 1:215 BELMONT DR SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-7513
Practice Address - Country:US
Practice Address - Phone:678-767-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-315655174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN