MEDICARE: JEFFREY A. FRIED, MD PC

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	207X00000X	Orthopaedic Surgery Physician		GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE6814	OTHER	GA	RAILROAD MEDICARE GRP #

General Provider Information

NPI Number	:	1255414587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY A. FRIED, MD PC

Provider Business Mailing Address
First Line	:	PO BOX 5048
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-5048
Country	:	US
Telephone Number	:	478-477-0966
Fax Number	:	478-475-0084

Provider Business Practice Location Address
First Line	:	6501 PEAKE RD
Second Line	:	BLDG 400
City	:	MACON
State	:	GA
Zip	:	31210-8042
Country	:	US
Telephone Number	:	478-477-0966
Fax Number	:	478-475-0084

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY A FRIED
Credential	:	M.D.
Telephone Number	:	478-477-0966

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	04/25/2012

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