Provider Demographics
NPI:1255327797
Name:KOEHLER, FREDRICK ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:ARTHUR
Last Name:KOEHLER
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:PO BOX 0070
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0070
Mailing Address - Country:US
Mailing Address - Phone:229-433-8741
Mailing Address - Fax:229-543-7120
Practice Address - Street 1:201 N BARTOW ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-1435
Practice Address - Country:US
Practice Address - Phone:229-686-2774
Practice Address - Fax:229-543-1348
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA453778874CMedicaid
GAD54632Medicare UPIN