Provider Demographics
NPI:1164893111
Name:GOLDEN, FREDERICK SR
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:GOLDEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 UPPER MULLER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-1143
Mailing Address - Country:US
Mailing Address - Phone:803-402-7730
Mailing Address - Fax:
Practice Address - Street 1:111 UPPER MULLER ST
Practice Address - Street 2:
Practice Address - City:SAINT MATTHEWS
Practice Address - State:SC
Practice Address - Zip Code:29135-1143
Practice Address - Country:US
Practice Address - Phone:803-402-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator