Healthcare Provider Details

I. General information

NPI: 1861482242
Provider Name (Legal Business Name): JONATHAN CHARLES FRUENDT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DESHLER ST SW
ATLANTA GA
30330-1040
US

IV. Provider business mailing address

7395 MOBLEY CT
WINSTON GA
30187-2233
US

V. Phone/Fax

Practice location:
  • Phone: 404-464-8212
  • Fax: 404-464-8200
Mailing address:
  • Phone: 678-838-7687
  • Fax: 404-464-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14416
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: