Healthcare Provider Details

I. General information

NPI: 1194630210
Provider Name (Legal Business Name): ANDREA I FLEIDERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 BOGAN MILL RD
BUFORD GA
30519-7340
US

IV. Provider business mailing address

3530 BOGAN MILL RD
BUFORD GA
30519-7340
US

V. Phone/Fax

Practice location:
  • Phone: 404-357-5116
  • Fax:
Mailing address:
  • Phone: 404-985-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: