Individual
HEATHER LEIGH FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
5310 MOSS OAK TRL, LAKE PARK, GA 31636-3300
(217) 299-1074
Mailing address
5310 MOSS OAK TRL, LAKE PARK, GA 31636-3300
(217) 299-1074
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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