Provider Demographics
NPI:1396736625
Name:FRIEDRICH, ERIC WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:FRIEDRICH
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 1:17 PROFESSIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3784
Mailing Address - Country:US
Mailing Address - Phone:912-275-7346
Mailing Address - Fax:912-275-8374
Practice Address - Street 1:17 PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3784
Practice Address - Country:US
Practice Address - Phone:912-275-7346
Practice Address - Fax:912-275-8374
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16344207QA0505X, 207Y00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29504Medicare UPIN
GA05BDCPKMedicare ID - Type Unspecified