Healthcare Provider Details

I. General information

NPI: 1194800375
Provider Name (Legal Business Name): RACHEL W FRIEDBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE SRPAC OFFICES
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD NE SRPAC OFFICES
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2338
  • Fax: 404-785-4820
Mailing address:
  • Phone: 404-785-2338
  • Fax: 404-785-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number061457
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: