Provider Demographics
NPI:1235127598
Name:BREME, FREDERICK J (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:BREME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 S MILLEDGE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1262
Mailing Address - Country:US
Mailing Address - Phone:706-353-0709
Mailing Address - Fax:706-549-3167
Practice Address - Street 1:598 S MILLEDGE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1262
Practice Address - Country:US
Practice Address - Phone:706-353-0709
Practice Address - Fax:706-549-3167
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000710103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00425631BMedicaid
GA00425631BMedicaid
GA68BBFWWMedicare ID - Type Unspecified