MEDICARE: SCOTT FRIEDER M.D.

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	024462	GA

General Provider Information

NPI Number	:	1740317999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT FRIEDER M.D.

Provider Business Mailing Address
First Line	:	2770 LENOX RD NE
Second Line	:	BUILD 2 STE 8
City	:	ATLANTA
State	:	GA
Zip	:	30324-6006
Country	:	US
Telephone Number	:	404-264-9553
Fax Number	:	404-266-2294

Provider Business Practice Location Address
First Line	:	2770 LENOX RD NE
Second Line	:	BUILD 2 STE 8
City	:	ATLANTA
State	:	GA
Zip	:	30324-6006
Country	:	US
Telephone Number	:	404-264-9553
Fax Number	:	404-266-2294

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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