Provider Demographics
NPI:1174162127
Name:FOSTER, JAWANZA
Entity type:Individual
Prefix:
First Name:JAWANZA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 US HIGHWAY 80 E UNIT A
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3921
Mailing Address - Country:US
Mailing Address - Phone:334-289-1193
Mailing Address - Fax:334-289-1196
Practice Address - Street 1:1502 US HIGHWAY 80 E UNIT A
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3921
Practice Address - Country:US
Practice Address - Phone:334-289-1193
Practice Address - Fax:334-289-1196
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator