Provider Demographics
NPI:1194800375
Name:FRIEDBERG, RACHEL W (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:W
Last Name:FRIEDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JOHNSON FERRY RD NE
Mailing Address - Street 2:SRPAC OFFICES
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1605
Mailing Address - Country:US
Mailing Address - Phone:404-785-2338
Mailing Address - Fax:404-785-4820
Practice Address - Street 1:1001 JOHNSON FERRY RD NE
Practice Address - Street 2:SRPAC OFFICES
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-2338
Practice Address - Fax:404-785-4820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061457208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC030548600Medicaid
MD250001902Medicaid
VA010202639Medicaid
018111C95Medicare ID - Type Unspecified
DC030548600Medicaid