Provider Demographics
NPI:1114023694
Name:SEAN M FOLEY MD PLLC
Entity type:Organization
Organization Name:SEAN M FOLEY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-256-9084
Mailing Address - Street 1:PO BOX 922088
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-2088
Mailing Address - Country:US
Mailing Address - Phone:888-702-3885
Mailing Address - Fax:770-709-3730
Practice Address - Street 1:5600 TENBURY WAY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8115
Practice Address - Country:US
Practice Address - Phone:888-708-3885
Practice Address - Fax:770-709-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003145928BMedicaid
FM003147657AMedicaid
GA202I252711Medicare UPIN
GA003145928BMedicaid