Provider Demographics
NPI:1710703442
Name:FOSTER, BENNY TATE
Entity type:Individual
Prefix:
First Name:BENNY
Middle Name:TATE
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 1:611 AIRBASE LN
Mailing Address - Street 2:
Mailing Address - City:BRICEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37710-2023
Mailing Address - Country:US
Mailing Address - Phone:865-748-8715
Mailing Address - Fax:
Practice Address - Street 1:611 AIRBASE LN
Practice Address - Street 2:
Practice Address - City:BRICEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37710-2023
Practice Address - Country:US
Practice Address - Phone:865-748-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0145794171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications