NPI age
16 years
Enumerated 2010-02-12
● Active
Type 1 · Individual
MR. Samuel Fenderson
Fenderson is 1 of 1 physician assistant providers in Stone Mountain and 1 of 640 in Georgia.
Primary specialty
Physician Assistant
Plus 1 subspecialty
Licensed in
—
0 states
Status
Active
No deactivations on record
Last NPPES update
2018-03-01
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 640 active physician assistant providers in Georgia.
NPI age
16 years
↑ 3 yr above median (13 yr)
State licenses
1 state
10% of peers hold multiple states
Subspecialties
1
In the 37% of peers with subspecialties
NPI lifetime · 2010 → 2026
2010-02Enumerated in NPPES
2010
2026
Where they practice
Practice location
925 Main St # 300-07
Stone Mountain, GA 300833098
Mailing address
925 Main St # 300-07
Stone Mountain, GA 300833098
Specialties
-
Physician Assistant PrimaryDefinition to come...
-
Specialist/Technologist, OtherA surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting,...
Practice context
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.