Provider Demographics
NPI:1265654644
Name:FREY, EDWARD LINDSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LINDSEY
Last Name:FREY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 CYNTHIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-261-7504
Mailing Address - Fax:404-477-3291
Practice Address - Street 1:455 EAST PACES FERRY ROAD
Practice Address - Street 2:325
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-261-7504
Practice Address - Fax:404-477-3291
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor