Basic Information
Provider Information
NPI: 1235172230
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOSTER
FirstName: JAMES
MiddleName: L
NamePrefix: DR.
NameSuffix: JR.
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 575 1ST ST
Address2:  
City: MACON
State: GA
PostalCode: 312012825
CountryCode: US
TelephoneNumber: 4787439762
FaxNumber: 4787466612
Practice Location
Address1: 575 1ST ST
Address2:  
City: MACON
State: GA
PostalCode: 312012825
CountryCode: US
TelephoneNumber: 4787439762
FaxNumber: 4787466612
Other Information
ProviderEnumerationDate: 06/14/2006
LastUpdateDate: 09/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X046099GAY Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

No ID Information.


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