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General NPI Number Information
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NPI Number | 1861482242
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Entity Type | Individual
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Provider Name | JONATHAN CHARLES FRUENDT M.D
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1401 DESHLER ST SW
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City | ATLANTA
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State | GA
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Zip | 30330-1040
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Country | US
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Telephone | 404-464-8212
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Fax | 404-464-8200
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Provider Business Mailing Address
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Address Line | 7395 MOBLEY CT
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City | WINSTON
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State | GA
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Zip | 30187-2233
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Country | US
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Telephone | 678-838-7687
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Fax | 404-464-8200
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14416
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License Number State | AL
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