Provider Demographics
NPI:1225805252
Name:FRIE, TIMOTHY NORMAN (MS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:NORMAN
Last Name:FRIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:TM
Other - Middle Name:
Other - Last Name:FRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:690 BEAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-5167
Mailing Address - Country:US
Mailing Address - Phone:813-538-9903
Mailing Address - Fax:
Practice Address - Street 1:320 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1614
Practice Address - Country:US
Practice Address - Phone:770-284-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education