Provider Demographics
NPI:1225050115
Name:FRITZSCHE, FREDERICK H (MD)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:H
Last Name:FRITZSCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5337
Mailing Address - Country:US
Mailing Address - Phone:229-226-7154
Mailing Address - Fax:229-226-1504
Practice Address - Street 1:4280 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-671-2019
Practice Address - Fax:229-671-2010
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00879788AMedicaid
GA00879788AMedicaid
GAH05872Medicare UPIN