Individual
DR. FRED DANIEL KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 MEDICAL WAY, SUITE 150, SNELLVILLE, GA 30078-2166
(770) 979-9903
(770) 979-7312
Mailing address
1600 MEDICAL WAY, SUITE 150, SNELLVILLE, GA 30078-2166
(770) 979-9903
(770) 979-7312
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
052122
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000982132C
—
GA
05
—
000982132D
—
GA
05
—
000982132E
—
GA
Enumeration date
08/13/2006
Last updated
08/13/2014
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