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General NPI Number Information
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NPI Number | 1053820399
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Entity Type | Organization
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Legal Business Name | FREDERICK C. SHAW & ASSOCIATES
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 645 ERNEST W BARRETT PKWY NW
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City | KENNESAW
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State | GA
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Zip | 30144-4922
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Country | US
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Telephone | 770-420-2268
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Fax | 770-825-9200
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Provider Business Mailing Address
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Address Line | 645 ERNEST W BARRETT PKWY NW
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City | KENNESAW
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State | GA
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Zip | 30144-4922
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Country | US
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Telephone | 770-420-2268
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MISS FREDA A THOMAS
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Credential |
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Telephone | 770-722-2344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1535
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License Number State | GA
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