Healthcare Provider Details

I. General information

NPI: 1619941911
Provider Name (Legal Business Name): FREDERICK TAYLOR WORK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALTIMORE PL NW SUITE 400
ATLANTA GA
30308-2116
US

IV. Provider business mailing address

1 BALTIMORE PL NW SUITE 400
ATLANTA GA
30308-2116
US

V. Phone/Fax

Practice location:
  • Phone: 404-885-9675
  • Fax: 404-875-4017
Mailing address:
  • Phone: 404-885-9675
  • Fax: 404-875-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number040593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: