Individual
MR. SAMUEL FENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 MAIN ST # 300-07, STONE MOUNTAIN, GA 30083-3098
(678) 799-2498
Mailing address
925 MAIN ST # 300-07, STONE MOUNTAIN, GA 30083-3098
(678) 799-2498
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
02/12/2010
Last updated
03/01/2018
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