Provider Demographics
NPI:1235124223
Name:FRIX, CAREY WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:WALLACE
Last Name:FRIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2231
Mailing Address - Country:US
Mailing Address - Phone:731-989-0001
Mailing Address - Fax:731-989-5151
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2231
Practice Address - Country:US
Practice Address - Phone:731-989-0001
Practice Address - Fax:731-989-5151
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00065503OtherRAILROAD MEDICARE
TN3868049Medicaid
TNG93440Medicare UPIN
TN3868049Medicaid