Individual
ROBERT FRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1627 WYNN LAKE RD, ALTO, GA 30510-5226
(706) 968-9150
Mailing address
PO BOX 495, BALDWIN, GA 30511-0495
(706) 968-9150
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY001124
GA
103TC0700X
Clinical Psychologist
PSY001124
GA
103TH0100X
Health Service Psychologist
PSY001124
GA
Other
Enumeration date
12/07/2013
Last updated
12/07/2013
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