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General NPI Number Information
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NPI Number | 1679436513
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Entity Type | Individual
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Provider Name | JUSTIN FRIALDE RN
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Gender | Male
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 2000 DAN PROCTOR DR
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City | SAINT MARYS
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State | GA
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Zip | 31558-3810
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Country | US
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Telephone | 912-576-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 204 COLLIN NICHOLAS DR
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City | KINGSLAND
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State | GA
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Zip | 31548-1337
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Country | US
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Telephone | 912-400-1788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 339666
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License Number State | GA
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