MEDICARE: FREDNE SPEIGHTS M.D./C.S.A.

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1659558161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDNE SPEIGHTS M.D./C.S.A.

Provider Business Mailing Address
First Line	:	7139 HIGHWAY 85 STE 115
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2900
Country	:	US
Telephone Number	:	404-222-0767
Fax Number	:

Provider Business Practice Location Address
First Line	:	7139 HIGHWAY 85
Second Line	:	STE. 115
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2900
Country	:	US
Telephone Number	:	404-222-0767
Fax Number	:

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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