Individual
PAUL D FOLENDORE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-AA
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(866) 507-5244
(855) 851-4405
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(855) 851-4405
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
003662
GA
367H00000X
Anesthesiologist Assistant
Primary
003662
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037320514A
—
GA
01
—
415235
WELLCARE
GA
01
—
P00450345
RAILROAD MEDICARE
GA
Enumeration date
10/23/2007
Last updated
02/05/2015
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