Provider Demographics
NPI:1326046277
Name:MCCARTER, FREDA D (MD)
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:D
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-221-1095
Mailing Address - Fax:404-221-1092
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-221-1095
Practice Address - Fax:404-221-1092
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053494208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA251230747AMedicaid
GA320119952OtherTIN
GA251230747AMedicaid
GA320119952OtherTIN