Healthcare Provider Details

I. General information

NPI: 1164726329
Provider Name (Legal Business Name): DREW FREILICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD STE 910
ATLANTA GA
30342-1731
US

IV. Provider business mailing address

5673 PEACHTREE DUNWOODY RD STE 910
ATLANTA GA
30342-1731
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-3822
  • Fax: 404-255-0495
Mailing address:
  • Phone: 404-255-3822
  • Fax: 404-255-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberTL36566
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number074034
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberTL36566
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: