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NPI Code Detail

MEDICARE: FREDRICK MICHAEL AMATRIAIN CRNA

MEDICARE: FREDRICK MICHAEL AMATRIAIN CRNA
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
1367500000XCertified Registered Nurse AnesthetistR80877SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881677367
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDRICK MICHAEL AMATRIAIN CRNA
Provider Business Mailing Address
First Line : PO BOX 2585
Second Line :
City : COLUMBUS
State : GA
Zip : 31902-2585
Country : US
Telephone Number : 706-660-8505
Fax Number : 706-660-9390
Provider Business Practice Location Address
First Line : 298 MEMORIAL DR
Second Line :
City : SENECA
State : SC
Zip : 29672-9443
Country : US
Telephone Number : 864-882-3351
Fax Number : 706-660-9390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/09/2008

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