Provider Demographics
NPI:1295828978
Name:FREDERICK, HUGHAN RH (MD)
Entity Type:Individual
Prefix:
First Name:HUGHAN
Middle Name:RH
Last Name:FREDERICK
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 707
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0707
Mailing Address - Country:US
Mailing Address - Phone:770-521-2229
Mailing Address - Fax:770-521-2231
Practice Address - Street 1:1015 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1507
Practice Address - Country:US
Practice Address - Phone:770-521-2229
Practice Address - Fax:770-521-2231
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056706207V00000X
MI4301078310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA824311960AMedicaid