Provider Demographics
NPI:1740984640
Name:FOSTER, PRISCILLA TATE (CNA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:TATE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5681
Mailing Address - Country:US
Mailing Address - Phone:504-810-6402
Mailing Address - Fax:
Practice Address - Street 1:709 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-5681
Practice Address - Country:US
Practice Address - Phone:504-810-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide