Provider Demographics
NPI:1316980139
Name:FOSTER, CARL A (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
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 1:6400 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5972
Mailing Address - Country:US
Mailing Address - Phone:706-478-5858
Mailing Address - Fax:706-478-0417
Practice Address - Street 1:6400 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5972
Practice Address - Country:US
Practice Address - Phone:706-478-5858
Practice Address - Fax:706-478-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23851207Q00000X, 207R00000X
GA057618207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAL19461Medicare UPIN