MEDICARE: DR. JOHN THOMAS FREDERICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	062983	GA

General Provider Information

NPI Number	:	1932303815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN THOMAS FREDERICK M.D.

Provider Business Mailing Address
First Line	:	1125 TROUPE ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4480
Country	:	US
Telephone Number	:	706-737-4575
Fax Number	:	706-731-5289

Provider Business Practice Location Address
First Line	:	630 13TH ST
Second Line	:	SUITE 250
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1015
Country	:	US
Telephone Number	:	706-724-2500
Fax Number	:	706-823-5928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	10/31/2013

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