=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275508327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA ELLIOTT FRICK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 CONNER DR BUILDING 3, SUITE 203
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-7039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-933-5600
-----------------------------------------------------
Fax | 919-933-5600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 CONNER DR BUILDING 3, SUITE 203
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-7039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-933-5600
-----------------------------------------------------
Fax | 919-933-5600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 19340
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------