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General NPI Number Information
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NPI Number | 1891701850
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Entity Type | Individual
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Provider Name | JEFFREY SCOT FRY LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 370 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5467
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Country | US
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Telephone | 866-525-2128
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Fax | 866-514-9557
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Provider Business Mailing Address
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Address Line | 3593 BROOKEFALL CT
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City | SUWANEE
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State | GA
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Zip | 30024-7033
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Country | US
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Telephone | 866-525-2128
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Fax | 866-514-9557
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW002889
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License Number State | GA
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