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NPI Profile for SAMUEL FENDERSON in STONE MOUNTAIN, GA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgical |
363AS0400X | 97 | Physician Assistant | |
Surgical Assistant |
246ZC0007X |
| NPI Number | 1326370545 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 02/12/2010 | |
| Last updated | 03/01/2018 - About 8 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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SAMUEL FENDERSON
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SAMUEL FENDERSON