Provider Demographics
NPI:1083736961
Name:EDWARD J FISHER JR MD INC
Entity Type:Organization
Organization Name:EDWARD J FISHER JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-316-1908
Mailing Address - Street 1:1361 JENNINGS MILL RD
Mailing Address - Street 2:BLDG 200 STE 201
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622
Mailing Address - Country:US
Mailing Address - Phone:706-316-1908
Mailing Address - Fax:706-316-2062
Practice Address - Street 1:1361 JENNINGS MILL RD
Practice Address - Street 2:BLDG 200 STE 201
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622
Practice Address - Country:US
Practice Address - Phone:706-316-1908
Practice Address - Fax:706-316-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0433692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDHCEMedicare ID - Type Unspecified
C01607Medicare UPIN