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NPI Code Detail

MEDICARE: EDWARD DENT FREDERICKSON MD

MEDICARE: EDWARD DENT FREDERICKSON 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
1207RN0300XNephrology Physician032384GA
2207R00000XInternal Medicine Physician032384GA

General Provider Information

NPI Number : 1386710085
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD DENT FREDERICKSON MD
Provider Business Mailing Address
First Line : 156 N MAIN ST
Second Line :
City : CLAYTON
State : GA
Zip : 30525-4266
Country : US
Telephone Number : 706-212-0390
Fax Number : 706-960-9209
Provider Business Practice Location Address
First Line : 156 N MAIN ST
Second Line :
City : CLAYTON
State : GA
Zip : 30525-4266
Country : US
Telephone Number : 706-212-0390
Fax Number : 706-960-9209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 07/29/2019

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Directions to “ EDWARD DENT FREDERICKSON MD” Practice Location

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