Individual
GASTON G FODERINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 GROSS CRESCENT CIR, FORT OGLETHORPE, GA 30742-3643
(706) 858-2000
(865) 291-3228
Mailing address
PO BOX 636019, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
052514
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00255604
RAILROAD MEDICARE
GA
Enumeration date
07/01/2006
Last updated
11/15/2007
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