Provider Demographics
NPI:1528479490
Name:FRIEDL, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:FRIEDL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY
Mailing Address - Street 2:STE 904
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1252
Mailing Address - Country:US
Mailing Address - Phone:770-487-7807
Mailing Address - Fax:770-487-7619
Practice Address - Street 1:2579 HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1451
Practice Address - Country:US
Practice Address - Phone:770-487-7807
Practice Address - Fax:770-487-7619
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily