Provider Demographics
NPI:1720249097
Name:FREDERICK, SARAH LINDSAY PROPHET (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LINDSAY PROPHET
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:PROPHET
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1026 GOODYEAR AVE STE 302B
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1194
Mailing Address - Country:US
Mailing Address - Phone:256-485-0899
Mailing Address - Fax:866-265-9563
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-543-3977
Practice Address - Fax:256-543-1339
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29899207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology