Provider Demographics
NPI:1346728375
Name:HIGHLANDS INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:HIGHLANDS INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FREDERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-212-0390
Mailing Address - Street 1:156 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-4266
Mailing Address - Country:US
Mailing Address - Phone:706-212-0390
Mailing Address - Fax:706-960-9209
Practice Address - Street 1:156 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4266
Practice Address - Country:US
Practice Address - Phone:706-212-0390
Practice Address - Fax:706-960-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty