Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 040383 | GA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 040383 | GA |
NPI | 1114007481 |
---|---|
Provider Name | Dr. Jeffrey A Fried |
First Address | Macon, GA 31208-5048 |
Second Address | Macon, GA 31210-8042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52448324 002 | BCBS PROVIDER # (01) | GA |
E55513 | (02) | GA |
P00308700 | RAIL ROAD MEDICARE # (01) | GA |