Provider Demographics
NPI:1811209893
Name:FREDLUND, ERIK TYLER (PA-C, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:TYLER
Last Name:FREDLUND
Suffix:
Gender:M
Credentials:PA-C, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2602 BROOKHAVEN VW NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3198
Mailing Address - Country:US
Mailing Address - Phone:404-374-0116
Mailing Address - Fax:
Practice Address - Street 1:2602 BROOKHAVEN VW NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3198
Practice Address - Country:US
Practice Address - Phone:404-374-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer