MEDICARE: EDITH FRESH PH.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	103T00000X	Psychologist	PSY1863

Other Identifiers

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

General Provider Information

NPI Number	:	1881704344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH FRESH PH.D.

Provider Business Mailing Address
First Line	:	75 PIEDMONT AVE
Second Line	:	STE 700
City	:	ATLANTA
State	:	GA
Zip	:	30303
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:	404-756-1400

Provider Business Practice Location Address
First Line	:	1513 EAST CLEVELAND AVE BLGD 500
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6903
Country	:	US
Telephone Number	:	404-752-1000
Fax Number	:	404-752-1191

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/25/2013

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Directions to “ EDITH FRESH PH.D.” Practice Location

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