Provider Demographics
NPI:1659721348
Name:FRIEDRICH, ERIC WILLIAM II
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:WILLIAM
Last Name:FRIEDRICH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EH DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2193
Mailing Address - Country:US
Mailing Address - Phone:912-275-7133
Mailing Address - Fax:912-335-5694
Practice Address - Street 1:160 EH DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2193
Practice Address - Country:US
Practice Address - Phone:912-275-7133
Practice Address - Fax:912-335-5694
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X, 372600000X
GA063-R-13093747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion