Provider Demographics
NPI:1295062289
Name:FREDERICK, JANE A (RN, MS,PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:FREDERICK
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Gender:F
Credentials:RN, MS,PHD
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Mailing Address - Street 1:1100 S MARIETTA PKWY SE # MD9004
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2855
Mailing Address - Country:US
Mailing Address - Phone:470-578-7391
Mailing Address - Fax:470-578-7161
Practice Address - Street 1:1100 S MARIETTA PKWY SE # MD9004
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:470-578-7391
Practice Address - Fax:470-578-7161
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2018-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN057224364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult