Provider Demographics
NPI:1811067838
Name:DEIGERT, FREDERICK AUGUSTINE (M D)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:AUGUSTINE
Last Name:DEIGERT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2543
Mailing Address - Country:US
Mailing Address - Phone:800-998-5859
Mailing Address - Fax:404-378-7460
Practice Address - Street 1:150 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2543
Practice Address - Country:US
Practice Address - Phone:800-998-5859
Practice Address - Fax:404-378-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060773A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTC64078Medicare UPIN