Provider Demographics
NPI:1467670430
Name:FRECHTER, HENRY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:DAVID
Last Name:FRECHTER
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 1:1616 BRIARCLIFF RD NE APT 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2114
Mailing Address - Country:US
Mailing Address - Phone:404-897-5172
Mailing Address - Fax:
Practice Address - Street 1:1616 BRIARCLIFF RD NE APT 1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2114
Practice Address - Country:US
Practice Address - Phone:404-897-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045465208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC63228Medicare UPIN