Provider Demographics
NPI:1457097941
Name:FOSTER, SHIRETHA VINESSA
Entity Type:Individual
Prefix:
First Name:SHIRETHA
Middle Name:VINESSA
Last Name:FOSTER
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 1:136 N 10TH ST APT 704
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-7294
Mailing Address - Country:US
Mailing Address - Phone:904-832-5415
Mailing Address - Fax:
Practice Address - Street 1:136 N 10TH ST APT 704
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-7294
Practice Address - Country:US
Practice Address - Phone:904-832-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)