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General NPI Number Information
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NPI Number | 1992076988
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Entity Type | Organization
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Legal Business Name | ROBERT M. FREDRICK, LCSW,PC
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE SUITE 508
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 404-636-1108
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Fax | 404-636-9482
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Provider Business Mailing Address
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Address Line | 2801 BUFORD HWY NE SUITE 508
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 404-636-1108
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Fax | 404-636-9482
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT M FREDRICK
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Credential | MSW
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Telephone | 404-636-1108
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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 | 000144
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License Number State | GA
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