MEDICARE: FREDRICK ARTHUR KOEHLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	055535	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255327797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDRICK ARTHUR KOEHLER MD

Provider Business Mailing Address
First Line	:	PO BOX 0070
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31603-0070
Country	:	US
Telephone Number	:	229-433-8741
Fax Number	:	229-543-7120

Provider Business Practice Location Address
First Line	:	201 N BARTOW ST
Second Line	:
City	:	NASHVILLE
State	:	GA
Zip	:	31639-1435
Country	:	US
Telephone Number	:	229-686-2774
Fax Number	:	229-543-1348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/06/2018

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