Provider Demographics
NPI:1043212731
Name:FOLEY, ANTHONY MATTHEW SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MATTHEW
Last Name:FOLEY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:594 S COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9094
Mailing Address - Country:US
Mailing Address - Phone:912-826-4057
Mailing Address - Fax:912-826-2853
Practice Address - Street 1:594 S COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9094
Practice Address - Country:US
Practice Address - Phone:912-826-4057
Practice Address - Fax:912-826-2853
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA047082208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105040AMedicaid
GA202I029836Medicare UPIN