Provider Demographics
NPI:1750575338
Name:ASTLE, FREDRICK J (PHD, APRN, PMHCNS-BC)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:J
Last Name:ASTLE
Suffix:
Gender:M
Credentials:PHD, APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5731
Mailing Address - Street 2:COLLEGE OF NURSING
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-5731
Mailing Address - Country:US
Mailing Address - Phone:803-256-2500
Mailing Address - Fax:803-758-1726
Practice Address - Street 1:2638 TWO NOTCH ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-256-2500
Practice Address - Fax:803-758-1726
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR38298163WP0808X
SC4291163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA72856580OtherMEDICARE PTAN