Provider Demographics
NPI:1316904147
Name:FRIEDMAN, JARED SAMUEL (MD)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:SAMUEL
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MARBLE MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1047
Mailing Address - Country:US
Mailing Address - Phone:770-422-1013
Mailing Address - Fax:770-514-5996
Practice Address - Street 1:111 MARBLE MILL RD NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1047
Practice Address - Country:US
Practice Address - Phone:770-422-1013
Practice Address - Fax:770-514-5996
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD52722207N00000X
GA052722207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00145724OtherMEDICARE RAILROAD
GA878435OtherBCBS
GA07BBSPJMedicare PIN
GA878435OtherBCBS
GAP00145724OtherMEDICARE RAILROAD