Provider Demographics
NPI:1659558161
Name:SPEIGHTS, FREDNE (MD/CSA)
Entity Type:Individual
Prefix:
First Name:FREDNE
Middle Name:
Last Name:SPEIGHTS
Suffix:
Gender:F
Credentials:MD/CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7139 HIGHWAY 85 STE 115
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2900
Mailing Address - Country:US
Mailing Address - Phone:404-222-0767
Mailing Address - Fax:
Practice Address - Street 1:7139 HIGHWAY 85
Practice Address - Street 2:STE. 115
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2900
Practice Address - Country:US
Practice Address - Phone:404-222-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other