| Highlands Internal Medicine, Pc | |
|
156 North Main St Clayton GA 30525-4266 | |
| (706) 212-0390 | |
| (706) 960-9209 |
| Full Name | Highlands Internal Medicine, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 156 North Main St, Clayton, Georgia |
| Authorized Official Name and Position | Edward D Frederickson (CEO) |
| Authorized Official Contact | 7062120390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Highlands Internal Medicine, Pc 156 North Main St Clayton GA 30525-4266 Ph: (706) 212-0390 | Highlands Internal Medicine, Pc 156 North Main St Clayton GA 30525-4266 Ph: (706) 212-0390 |
| NPI Number | 1346728375 |
|---|---|
| Provider Enumeration Date | 08/01/2018 |
| Last Update Date | 08/01/2018 |
| Medicare PECOS PAC ID | 4789929589 |
|---|---|
| Medicare Enrollment ID | O20181226001031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346728375 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Edward Dent Frederickson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386710085 PECOS PAC ID: 9830136100 Enrollment ID: I20120203000433 |
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