Provider Demographics
NPI:1659328862
Name:FOLEY, SEAN M (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:FOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:888-708-3885
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:888-708-3873
Practice Address - Fax:770-709-3730
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4081208100000X
GA069002208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003145928BMedicaid
GA003147657AMedicaid
AR5M940OtherBCBS
AR156265001Medicaid
GA003145928BMedicaid
AR5M940OtherBCBS
GA003147657AMedicaid