Healthcare Provider Details

I. General information

NPI: 1740317999
Provider Name (Legal Business Name): SCOTT FRIEDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 LENOX RD NE BUILD 2 STE 8
ATLANTA GA
30324-6006
US

IV. Provider business mailing address

2770 LENOX RD NE BUILD 2 STE 8
ATLANTA GA
30324-6006
US

V. Phone/Fax

Practice location:
  • Phone: 404-264-9553
  • Fax: 404-266-2294
Mailing address:
  • Phone: 404-264-9553
  • Fax: 404-266-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number024462
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: