Individual
FRIEDA WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3110 CLIFTON SPRINGS RD STE B, DECATUR, GA 30034-4600
(404) 244-2200
Mailing address
445 WINN WAY, DECATUR, GA 30030-1707
(404) 294-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
277449
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032697982
DRIVER'S LICENSE
GA
Enumeration date
06/23/2022
Last updated
06/23/2022
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