Healthcare Provider Details

I. General information

NPI: 1144152976
Provider Name (Legal Business Name): MRS. FREDRICA WALDBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6205 ABERCORN ST
SAVANNAH GA
31405-5527
US

IV. Provider business mailing address

6205 ABERCORN ST
SAVANNAH GA
31405-5527
US

V. Phone/Fax

Practice location:
  • Phone: 912-703-3629
  • Fax:
Mailing address:
  • Phone: 912-703-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number059044653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: