Healthcare Provider Details

I. General information

NPI: 1659558161
Provider Name (Legal Business Name): FREDNE SPEIGHTS M.D./C.S.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7139 HIGHWAY 85 STE. 115
RIVERDALE GA
30274-2900
US

IV. Provider business mailing address

7139 HIGHWAY 85 STE 115
RIVERDALE GA
30274-2900
US

V. Phone/Fax

Practice location:
  • Phone: 404-222-0767
  • Fax:
Mailing address:
  • Phone: 404-222-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: