1114023694 NPI number — SEAN M FOLEY MD PLLC

Table of content: (NPI 1114023694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114023694 NPI number — SEAN M FOLEY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEAN M FOLEY MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114023694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 922088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30010-2088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-702-3885
Provider Business Mailing Address Fax Number:
770-709-3730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 TENBURY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30022-8115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-708-3885
Provider Business Practice Location Address Fax Number:
770-709-3730
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-256-9084

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003145928B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003147657A , issued by the state of ( FM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com