Individual
EDWARD DENT FREDERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
156 N MAIN ST, CLAYTON, GA 30525-4266
(706) 212-0390
(706) 960-9209
Mailing address
156 N MAIN ST, CLAYTON, GA 30525-4266
(706) 212-0390
(706) 960-9209
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
032384
GA
207RN0300X
Nephrology Physician
032384
GA
Other
Enumeration date
11/27/2006
Last updated
07/29/2019
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