Provider Demographics
NPI:1992040562
Name:FOSTER, STEPHEN G (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7947 GLADE HILL CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4510
Mailing Address - Country:US
Mailing Address - Phone:404-886-8705
Mailing Address - Fax:770-874-5469
Practice Address - Street 1:3900 JUNIUS ST STE 705
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1627
Practice Address - Country:US
Practice Address - Phone:770-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6685363A00000X
TXPA08811363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant